Healthcare Provider Details

I. General information

NPI: 1073873170
Provider Name (Legal Business Name): WILLIAM RANDAL BYARS COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 HOLLYWOOD AVE
NORMAN OK
73072-6023
US

IV. Provider business mailing address

1512 HOLLYWOOD AVE
NORMAN OK
73072-6023
US

V. Phone/Fax

Practice location:
  • Phone: 405-650-9029
  • Fax: 405-360-2527
Mailing address:
  • Phone: 405-650-9029
  • Fax: 405-360-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number476
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: