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General NPI Number Information
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NPI Number | 1841090974
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Entity Type | Individual
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Provider Name | KIMBERLY RENEE CONNOLLEY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1012 24TH AVE NW
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City | NORMAN
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State | OK
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Zip | 73069-6490
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Country | US
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Telephone | 405-601-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 SE 163RD CT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73165-1603
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Country | US
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Telephone | 405-343-7282
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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 | 2698
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License Number State | OK
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