Provider Demographics
NPI:1609524396
Name:SPANN, ANNA GRACE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:SPANN
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 1:1504 KATHLEEN ST APT 1204
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-9448
Mailing Address - Country:US
Mailing Address - Phone:870-351-2704
Mailing Address - Fax:
Practice Address - Street 1:970 COUNTY ROAD 753
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-0232
Practice Address - Country:US
Practice Address - Phone:870-219-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant