Provider Demographics
NPI:1568160711
Name:DEPROW, ALISSA BROOKE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:BROOKE
Last Name:DEPROW
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 1:1089 HIGHWAY 91 W
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8112
Mailing Address - Country:US
Mailing Address - Phone:870-219-1027
Mailing Address - Fax:
Practice Address - Street 1:1089 HIGHWAY 91 W
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-8112
Practice Address - Country:US
Practice Address - Phone:870-219-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1913224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant