Provider Demographics
NPI:1104133685
Name:GOLD, KORTNEY E (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:KORTNEY
Middle Name:E
Last Name:GOLD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:KORTNEY
Other - Middle Name:E
Other - Last Name:COATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:221 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3813
Mailing Address - Country:US
Mailing Address - Phone:501-772-6231
Mailing Address - Fax:
Practice Address - Street 1:1600 RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-663-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-2227225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics