Provider Demographics
NPI:1053065458
Name:COLLINS, MORGAN NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:NICOLE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4905 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1285
Mailing Address - Country:US
Mailing Address - Phone:501-804-3765
Mailing Address - Fax:
Practice Address - Street 1:4905 SUNNY LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-1285
Practice Address - Country:US
Practice Address - Phone:501-804-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226000000X
AROT-A1834224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant