Provider Demographics
NPI:1174277495
Name:TREADWELL, PAIGE MAEANN (COTA)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MAEANN
Last Name:TREADWELL
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 1:189 PEKOE LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-8182
Mailing Address - Country:US
Mailing Address - Phone:870-504-3554
Mailing Address - Fax:870-505-2016
Practice Address - Street 1:600 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5006
Practice Address - Country:US
Practice Address - Phone:870-715-5359
Practice Address - Fax:870-505-2016
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2022-005224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty