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General NPI Number Information
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NPI Number | 1245925635
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Entity Type | Individual
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Provider Name | STEPHANIE DAWN LAND COTA/L.ATP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 408 S MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-6992
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Country | US
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Telephone | 405-410-8814
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Fax |
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Provider Business Mailing Address
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Address Line | 5616 TIGER STONE DR
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City | MUSTANG
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State | OK
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Zip | 73064-7277
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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 | OTA2346
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License Number State | OK
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