Individual
KOTA TAKAHASHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1005 S SCHOOL AVE, FAYETTEVILLE, AR 72701-5574
(479) 283-6931
Mailing address
1005 S SCHOOL AVE, FAYETTEVILLE, AR 72701-5574
(479) 283-6931
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/12/2024
Last updated
01/12/2024
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