Provider Demographics
NPI:1093172579
Name:SINK, NAOMI (COTA/L)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:SINK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 LEE 908
Mailing Address - Street 2:
Mailing Address - City:MORO
Mailing Address - State:AR
Mailing Address - Zip Code:72368-9316
Mailing Address - Country:US
Mailing Address - Phone:870-270-7787
Mailing Address - Fax:
Practice Address - Street 1:1825 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3409
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2015-048224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant