Kita Renee Mooneyham, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

213706 Issued in TX

Practice address

8733 Blackman Ferry Rd
Texarkana, AR 71854-0235

Phone

(903) 506-2000

NPI assigned

Jul 1, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kita Renee Vaughn Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1699392068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8733 BLACKMAN FERRY RD",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718540235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8733 BLACKMAN FERRY RD",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718540235",
            "telephone_number": "903-506-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEYHAM",
        "first_name": "KITA",
        "middle_name": "RENEE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "213706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Rehabsolutions.com",
            "affiliation": "N",
            "endpointDescription": "Web based",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8733 Blackman Ferry Rd",
            "city": "Texarkana",
            "state": "AR",
            "country_code": "US",
            "postal_code": "718540235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KITA",
            "last_name": "VAUGHN",
            "middle_name": "RENEE",
            "credential": "COTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresa Milner
• Mary Mobley
• Glen Owen Monk
• Jesse Louis Montgomery III, MHPP
• Moonbrook Mind & Body Integrative Services Incorporated
• Callie Moore
• Joseph Eugene Moore, MD
• Kelley Rene Moore, MHPP
• Jerry Franklin Morgan Jr., RPH
• Regina Morgan

• Occupational Therapy Assistant in Texarkana, AR
• Providers in Texarkana, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.