Individual
TABITHA DAWN COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1601 GREENHOUSE RD, BENTONVILLE, AR 72713-9292
(479) 795-1260
(479) 795-1261
Mailing address
440 SIGEL TRL, CENTERTON, AR 72719-9441
(479) 659-1857
(479) 621-8506
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1455OTR
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137338721
—
AR
01
—
5U652
BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/11/2006
Last updated
10/01/2018
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