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NPI Code Detail

MEDICARE: MRS. MEGAN SELF COTA/L

MEDICARE: MRS. MEGAN SELF COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant1461OK

General Provider Information

NPI Number : 1336566553
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MEGAN SELF COTA/L
Provider Business Mailing Address
First Line : 1029 E WASHINGTON AVE
Second Line :
City : MCALESTER
State : OK
Zip : 74501-4862
Country : US
Telephone Number : 918-423-2220
Fax Number :
Provider Business Practice Location Address
First Line : 1029 E WASHINGTON AVE
Second Line :
City : MCALESTER
State : OK
Zip : 74501-4862
Country : US
Telephone Number : 918-423-2220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2014
Last Update Date : 11/20/2015

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Directions to “ MRS. MEGAN SELF COTA/L” Practice Location

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