Provider Demographics
NPI:1336740760
Name:DENNIS, WILLIAM JAY (COTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:DENNIS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:AR
Mailing Address - Zip Code:71770-9069
Mailing Address - Country:US
Mailing Address - Phone:870-949-5334
Mailing Address - Fax:
Practice Address - Street 1:406 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3226
Practice Address - Country:US
Practice Address - Phone:903-942-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211837224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant