Provider Demographics
NPI:1275259970
Name:LATCHAW, BAILEY GRACE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:GRACE
Last Name:LATCHAW
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 1:109 RYAN RD APT 3
Mailing Address - Street 2:
Mailing Address - City:COTTER
Mailing Address - State:AR
Mailing Address - Zip Code:72626-9208
Mailing Address - Country:US
Mailing Address - Phone:501-859-4093
Mailing Address - Fax:
Practice Address - Street 1:707 N CARDINAL DR STE 4
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3274
Practice Address - Country:US
Practice Address - Phone:870-404-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1886224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant