Provider Demographics
NPI:1831731595
Name:HESTIR, RANDI CARANN (COTA-L)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:CARANN
Last Name:HESTIR
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 1:601 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2727
Mailing Address - Country:US
Mailing Address - Phone:870-946-1606
Mailing Address - Fax:870-946-2739
Practice Address - Street 1:601 S UNION ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2727
Practice Address - Country:US
Practice Address - Phone:870-946-1606
Practice Address - Fax:870-946-2739
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCOTA1546224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCOTA1546OtherCOTA1546