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General NPI Number Information
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NPI Number | 1073131181
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Entity Type | Individual
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Provider Name | ALANA MARIE JORDAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 251 W 70TH ST S
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City | MUSKOGEE
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State | OK
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Zip | 74401-8924
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Country | US
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Telephone | 580-982-8316
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Fax |
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Provider Business Mailing Address
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Address Line | 849 W DELAWARE ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3425
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Country | US
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Telephone | 479-220-7164
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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 | 2084
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License Number State | OK
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