Provider Demographics
NPI:1053682237
Name:WELCH, SHANA (COTA)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 OLD STRONG HWY
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:AR
Mailing Address - Zip Code:71765-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 OLD STRONG HWY
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:AR
Practice Address - Zip Code:71765
Practice Address - Country:US
Practice Address - Phone:870-797-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A674224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant