Healthcare Provider Details

I. General information

NPI: 1982578241
Provider Name (Legal Business Name): SHERICE WALTERS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WILL ROGERS PKWY STE 600
OKLAHOMA CITY OK
73108-1808
US

IV. Provider business mailing address

1213 W FULTON ST
BROKEN ARROW OK
74012-7689
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-2813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2105
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: