Healthcare Provider Details

I. General information

NPI: 1902728934
Provider Name (Legal Business Name): BROOKLYN SHAE AQUILA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROSEDALE RD
ADA OK
74820-9220
US

IV. Provider business mailing address

9816 COUNTY ROAD 3579
ADA OK
74820-4724
US

V. Phone/Fax

Practice location:
  • Phone: 580-495-8789
  • Fax:
Mailing address:
  • Phone: 918-752-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2681
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: