Provider Demographics
NPI:1255056404
Name:SELF, ELIZABETH LEIGH (COTA)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:SELF
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 CHEVIOT PL
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-5405
Mailing Address - Country:US
Mailing Address - Phone:870-468-6161
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-2001
Practice Address - Country:US
Practice Address - Phone:870-569-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant