Provider Demographics
NPI:1720566961
Name:MOLDEN, LAURA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MOLDEN
Suffix:
Gender:F
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 1:2620 VALLEY FRG
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3078
Mailing Address - Country:US
Mailing Address - Phone:501-722-8130
Mailing Address - Fax:
Practice Address - Street 1:1412 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3050
Practice Address - Country:US
Practice Address - Phone:501-847-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1385224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant