Healthcare Provider Details

I. General information

NPI: 1356933675
Provider Name (Legal Business Name): CAROL AULNER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 S SANTA FE AVE APT 206
MOORE OK
73160-2859
US

IV. Provider business mailing address

2206 S SANTA FE AVE APT 206
MOORE OK
73160-2859
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-4452
  • Fax:
Mailing address:
  • Phone: 405-862-6065
  • Fax: 405-931-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2184
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: