Provider Demographics
NPI:1770331365
Name:TOMPKINS, CHARLI MEGAN (COTA)
Entity type:Individual
Prefix:
First Name:CHARLI
Middle Name:MEGAN
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CHARLI
Other - Middle Name:MEGAN
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTA
Mailing Address - Street 1:102 LITTLE RIVER 721
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-8641
Mailing Address - Country:US
Mailing Address - Phone:903-748-9886
Mailing Address - Fax:
Practice Address - Street 1:950 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-4304
Practice Address - Country:US
Practice Address - Phone:870-898-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOTA218292224Z00000X
AROT-A2013224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant