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General NPI Number Information
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NPI Number | 1023228517
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Entity Type | Individual
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Provider Name | JOEL BRYNN LIVINGSTON COTA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 602 SE WALLOCK ST
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City | LAWTON
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State | OK
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Zip | 73501-5444
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Country | US
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Telephone | 580-355-1512
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Fax | 580-355-1513
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Provider Business Mailing Address
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Address Line | 522 E. EVANS
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City | APACHE
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State | OK
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Zip | 73006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OA584
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License Number State | OK
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