Provider Demographics
NPI:1326235318
Name:HENDERSON, KATHERINE ELIZABETH (COTA)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:HENDERSON
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 1:607 E 7TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4016
Mailing Address - Country:US
Mailing Address - Phone:870-875-1128
Mailing Address - Fax:
Practice Address - Street 1:1320 MAUL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-2618
Practice Address - Country:US
Practice Address - Phone:870-836-2690
Practice Address - Fax:870-836-6270
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0759224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant