Most Relevant Information
Provider Data
| NPI Number: | 1003214982 |
| Provider Name: | NICOLE CLAIRE WILSON COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | OT-A962 |
Most Important Dates
| Enumeration Date: | 12/09/2014 |
| Last Updated: | 11/16/2021 |
Provider Practice Location
2508 GUNPOWDER RD
LITTLE ROCK
AR
722273029
Practice Location Phone/Fax
| Phone: | 5202403723 |
| Fax: |
Provider Mailing Location
2508 GUNPOWDER RD
LITTLE ROCK
AR
722273029
Provider Mailing Phone/Fax
| Phone: | 5202403723 |
| Fax: |