Provider Demographics
NPI:1699258475
Name:FLANAGAN, ANTHONY BRIAN (COTA/L)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRIAN
Last Name:FLANAGAN
Suffix:
Gender:M
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 1:4509 KEY LARGO PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7883
Mailing Address - Country:US
Mailing Address - Phone:870-316-1984
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHWEST SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5984
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1407224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty