Provider Demographics
NPI:1437110392
Name:HARDIN, MARIANNA FRANCES (COTA L)
Entity Type:Individual
Prefix:MISS
First Name:MARIANNA
Middle Name:FRANCES
Last Name:HARDIN
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 1:600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4223
Mailing Address - Country:US
Mailing Address - Phone:870-240-3312
Mailing Address - Fax:870-236-3103
Practice Address - Street 1:4407 AMARILLO ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-5702
Practice Address - Country:US
Practice Address - Phone:870-532-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA89224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant