Provider Demographics
NPI:1245660356
Name:FRIESEN, ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MEDINAH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6759
Mailing Address - Country:US
Mailing Address - Phone:501-580-7369
Mailing Address - Fax:
Practice Address - Street 1:14701 CECIL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1913
Practice Address - Country:US
Practice Address - Phone:501-225-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A710224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant