Provider Demographics
NPI:1730684051
Name:OLDHAM, CARSON (COTA/L)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:OLDHAM
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 1:2007 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4136
Mailing Address - Country:US
Mailing Address - Phone:870-248-1448
Mailing Address - Fax:870-248-1450
Practice Address - Street 1:2007 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4136
Practice Address - Country:US
Practice Address - Phone:870-248-1448
Practice Address - Fax:870-248-1450
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1356224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant