Provider Demographics
NPI:1073935276
Name:RIDER, ADAM HEATH (COTA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:HEATH
Last Name:RIDER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOUTHPARK SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-3307
Mailing Address - Country:US
Mailing Address - Phone:870-845-5600
Mailing Address - Fax:870-845-5605
Practice Address - Street 1:22 SOUTHPARK SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3307
Practice Address - Country:US
Practice Address - Phone:870-845-5600
Practice Address - Fax:870-845-5605
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A821224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant