Provider Demographics
NPI:1134760333
Name:THOMAS, PEYTON DAVID (COTA/L)
Entity type:Individual
Prefix:MR
First Name:PEYTON
Middle Name:DAVID
Last Name:THOMAS
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 1:8000 RIVER POINTE DR APT 8A14
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-8022
Mailing Address - Country:US
Mailing Address - Phone:870-245-6403
Mailing Address - Fax:
Practice Address - Street 1:2700 N PRICKETT RD STE 2
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7511
Practice Address - Country:US
Practice Address - Phone:501-213-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1532224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant