Provider Demographics
NPI:1679925499
Name:GOODSON, EMILY (COTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5986 HIGHWAY 79 W
Mailing Address - Street 2:
Mailing Address - City:MORO
Mailing Address - State:AR
Mailing Address - Zip Code:72368-8929
Mailing Address - Country:US
Mailing Address - Phone:870-295-0471
Mailing Address - Fax:870-633-3304
Practice Address - Street 1:726 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2854
Practice Address - Country:US
Practice Address - Phone:870-633-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1104224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant