Healthcare Provider Details

I. General information

NPI: 1205468618
Provider Name (Legal Business Name): NATALIE GISELE PYBAS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE GISELE JOHNSTON

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 LAUREL ST
JUNCTION CITY OR
97448
US

IV. Provider business mailing address

891 LAUREL ST
JUNCTION CITY OR
97448
US

V. Phone/Fax

Practice location:
  • Phone: 405-476-0522
  • Fax:
Mailing address:
  • Phone: 405-476-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number433503
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2163
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202008664
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: