Individual
MIKAYLIN SHAY COLLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
910 NW 7TH ST, BENTONVILLE, AR 72712-4565
(479) 250-9838
Mailing address
109 FAWN TRL, SENECA, MO 64865-8551
(417) 389-6483
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1620
AR
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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