Provider Demographics
NPI:1053004101
Name:COLLINS, KATE (COTA/L)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:COLLINS
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 1:3785 MADISON 8270
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-7858
Mailing Address - Country:US
Mailing Address - Phone:479-721-2690
Mailing Address - Fax:
Practice Address - Street 1:2801 OLD GREENWOOD RD #14
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4560
Practice Address - Country:US
Practice Address - Phone:479-222-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-07-03
Deactivation Date:2023-06-13
Deactivation Code:
Reactivation Date:2023-06-29
Provider Licenses
StateLicense IDTaxonomies
AROT-A1674224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant