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General NPI Number Information
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NPI Number | 1497132856
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Entity Type | Individual
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Provider Name | TANYA LOREE PETREE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 5813 E 143RD PL S
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City | BIXBY
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State | OK
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Zip | 74008-4138
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Country | US
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Telephone | 405-706-7355
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Fax |
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Provider Business Mailing Address
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Address Line | 5813 E 143RD PL S
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City | BIXBY
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State | OK
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Zip | 74008-4138
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Country | US
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Telephone | 405-706-7355
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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 | 515
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License Number State | OK
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