Most Relevant Information
Provider Data
| NPI Number: | 1003633918 |
| Provider Name: | KACEY JOHNSON COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | OT-A2002 |
Most Important Dates
| Enumeration Date: | 09/23/2024 |
| Last Updated: | 09/23/2024 |
Provider Practice Location
2911 LONGVIEW DR
JONESBORO
AR
724015911
Practice Location Phone/Fax
| Phone: | 8703360238 |
| Fax: |
Provider Mailing Location
329 COUNTY ROAD 485
RECTOR
AR
724618709
Provider Mailing Phone/Fax
| Phone: | 8707830666 |
| Fax: |