Healthcare Provider Details

I. General information

NPI: 1952218455
Provider Name (Legal Business Name): SHELBY L CHRISTIE L CHRISTIE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E CREEK AVE
SALLISAW OK
74955-4608
US

IV. Provider business mailing address

102727 S 4614 RD
SALLISAW OK
74955-5690
US

V. Phone/Fax

Practice location:
  • Phone: 918-208-3775
  • Fax:
Mailing address:
  • Phone: 479-414-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2174
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: