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General NPI Number Information
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NPI Number | 1124827746
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Entity Type | Individual
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Provider Name | ALLYSON NICOLE PEREZ COTA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 200 S RANCHWOOD BLVD STE 17
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City | YUKON
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State | OK
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Zip | 73099-2743
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Country | US
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Telephone | 405-694-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 528 AMITY LN
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City | EL RENO
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State | OK
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Zip | 73036-5611
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Country | US
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Telephone | 580-309-2262
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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 | 2706
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License Number State | OK
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