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General NPI Number Information
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NPI Number | 1184440489
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Entity Type | Individual
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Provider Name | HALEY RAFFERTY COTA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 5110 S YALE AVE STE 102
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City | TULSA
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State | OK
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Zip | 74135-7438
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Country | US
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Telephone | 918-492-2386
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Fax | 918-645-8686
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Provider Business Mailing Address
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Address Line | 8255 S 4040 RD
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City | TALALA
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State | OK
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Zip | 74080-3691
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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 | 2667
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License Number State | OK
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