Provider Demographics
NPI:1053536474
Name:COTTRELL, ELIZABETH ALLRED (MS, OTR L)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ALLRED
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:MS, OTR L
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR L
Mailing Address - Street 1:2762 E BIRDIE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6549
Mailing Address - Country:US
Mailing Address - Phone:479-443-0947
Mailing Address - Fax:
Practice Address - Street 1:403 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5333
Practice Address - Country:US
Practice Address - Phone:479-750-6240
Practice Address - Fax:479-750-6627
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 1151225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U619OtherBCBS PROVIDER #