Provider Demographics
NPI:1033541826
Name:FERGUSON, AMY LEA (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0232
Mailing Address - Country:US
Mailing Address - Phone:479-857-0532
Mailing Address - Fax:479-495-2622
Practice Address - Street 1:540 MOUDY RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72824-8816
Practice Address - Country:US
Practice Address - Phone:479-857-0532
Practice Address - Fax:479-495-3617
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT1315224Z00000X
AROT2023-001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROT1315OtherARKANSAS LIC