Healthcare Provider Details

I. General information

NPI: 1508070210
Provider Name (Legal Business Name): AMBER DAWNELL MCCORMICK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N. ARAPAHO
HYDRO OK
73048
US

IV. Provider business mailing address

PO BOX 133
HINTON OK
73047-0133
US

V. Phone/Fax

Practice location:
  • Phone: 405-663-2335
  • Fax:
Mailing address:
  • Phone: 405-542-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number900
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: