Healthcare Provider Details

I. General information

NPI: 1104735273
Provider Name (Legal Business Name): GABRIEL FRICKER COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N YORK ST STE H
MUSKOGEE OK
74403-1442
US

IV. Provider business mailing address

109 N 44TH WEST AVE
TULSA OK
74127-6306
US

V. Phone/Fax

Practice location:
  • Phone: 918-912-2796
  • Fax:
Mailing address:
  • Phone: 918-949-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3028
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: