Provider Demographics
NPI:1265957526
Name:CARTER, ANGELA SUZANNE (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUZANNE
Last Name:CARTER
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 1:3099 EAGLECREST CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8093
Mailing Address - Country:US
Mailing Address - Phone:479-466-8651
Mailing Address - Fax:
Practice Address - Street 1:3801 JOHNSON MILL BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5297
Practice Address - Country:US
Practice Address - Phone:479-856-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1238225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROT-A1238OtherCOTA