Provider Demographics
NPI:1114386976
Name:HENLEY, ELIZABETH KAY (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAY
Last Name:HENLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KAY
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5180 HEMSTEAD 3
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801
Mailing Address - Country:US
Mailing Address - Phone:870-703-6751
Mailing Address - Fax:
Practice Address - Street 1:5180 HEMSTEAD 3
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801
Practice Address - Country:US
Practice Address - Phone:870-703-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist