=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104212224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY KINCHELOE GREER COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2015
-----------------------------------------------------
Last Update Date | 04/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 E SKELLY DRIVE SUITE #402
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-827-3307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8 5401 WEST 191ST SOUTH
-----------------------------------------------------
City | MOUNDS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74047-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-827-3307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 369
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------