Healthcare Provider Details

I. General information

NPI: 1932798444
Provider Name (Legal Business Name): MAESYN ALYXANDRIA BARTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N. MAIN ST.
KINGFISHER OK
73750
US

IV. Provider business mailing address

19734 N 2810 RD
KINGFISHER OK
73750-7105
US

V. Phone/Fax

Practice location:
  • Phone: 580-356-9976
  • Fax:
Mailing address:
  • Phone: 501-804-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2243
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: