Healthcare Provider Details

I. General information

NPI: 1316851033
Provider Name (Legal Business Name): KYLI LOVE PEELER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N LEE ST
ALTUS OK
73521-3817
US

IV. Provider business mailing address

219 N LEE ST
ALTUS OK
73521-3817
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-2100
  • Fax:
Mailing address:
  • Phone: 580-481-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2382
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: