Provider Demographics
NPI:1215732748
Name:TABLER, TABITHA TAILY (COTA)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:TAILY
Last Name:TABLER
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:185 CORNERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6500
Mailing Address - Country:US
Mailing Address - Phone:501-525-4855
Mailing Address - Fax:501-525-5812
Practice Address - Street 1:3432 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2747
Practice Address - Country:US
Practice Address - Phone:870-330-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR526581224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant