Provider Demographics
NPI:1346931474
Name:COTTER, KEELEY (OTD)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WHITHORN CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-4021
Mailing Address - Country:US
Mailing Address - Phone:479-234-7680
Mailing Address - Fax:
Practice Address - Street 1:2510 W HUDSON RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2072
Practice Address - Country:US
Practice Address - Phone:479-936-1061
Practice Address - Fax:855-812-1132
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist