Individual
TAYLOR VONGPHAKDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
128 SOUTHWINDS RD STE 7, FARMINGTON, AR 72730-8678
(479) 267-2777
Mailing address
128 SOUTHWINDS RD STE 7, FARMINGTON, AR 72730-8678
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1255
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-A1255
STATE LICENSE NUMBER
AR
Enumeration date
12/10/2019
Last updated
12/10/2019
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