Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTR 1151 | AR |
NPI | 1053536474 |
---|---|
Provider Name | Mrs. Elizabeth Allred Cottrell |
First Address | Fayetteville, AR 72703-6549 |
Second Address | Springdale, AR 72764-5333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5U619 | BCBS PROVIDER # (01) | AR |