Healthcare Provider Details

I. General information

NPI: 1669061735
Provider Name (Legal Business Name): SANDRA CRISTINA MILES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW 89TH ST STE D200
OKLAHOMA CITY OK
73159-6383
US

IV. Provider business mailing address

1601 SW 89TH ST STE D200
OKLAHOMA CITY OK
73159-6383
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-3660
  • Fax: 405-602-0918
Mailing address:
  • Phone: 405-601-3660
  • Fax: 405-602-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1436
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: