Healthcare Provider Details

I. General information

NPI: 1437087764
Provider Name (Legal Business Name): AUDREY ESTELL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PARKLAWN DR
MIDWEST CITY OK
73110-4204
US

IV. Provider business mailing address

241 E JARMAN DR
MIDWEST CITY OK
73110-5025
US

V. Phone/Fax

Practice location:
  • Phone: 405-414-3489
  • Fax:
Mailing address:
  • Phone: 405-414-3489
  • Fax: 405-414-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1155
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: