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General NPI Number Information
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NPI Number | 1255898029
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Entity Type | Individual
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Provider Name | DANIEL LATIOLAIS COTA
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Gender | Male
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 3030 NW EXPRESSWAY STE 809
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5466
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Country | US
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Telephone | 866-848-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 900 CROOKED OAK CIR
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City | GUTHRIE
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State | OK
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Zip | 73044-8134
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Country | US
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Telephone | 337-255-5104
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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 | 1584
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License Number State | OK
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