Individual
KITA RENEE MOONEYHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
8733 BLACKMAN FERRY RD, TEXARKANA, AR 71854-0235
(903) 506-2000
Mailing address
8733 BLACKMAN FERRY RD, TEXARKANA, AR 71854-0235
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213706
TX
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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