Provider Demographics
NPI:1508224593
Name:CARTER, JUSTIN NEIL (COTA/L)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:NEIL
Last Name:CARTER
Suffix:
Gender:M
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 1:240 MATTHEWS DR
Mailing Address - Street 2:G102
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-9614
Mailing Address - Country:US
Mailing Address - Phone:870-500-5158
Mailing Address - Fax:
Practice Address - Street 1:615 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9061
Practice Address - Country:US
Practice Address - Phone:870-356-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A728224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant