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General NPI Number Information
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NPI Number | 1902728934
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Entity Type | Individual
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Provider Name | BROOKLYN SHAE AQUILA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 300 ROSEDALE RD
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City | ADA
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State | OK
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Zip | 74820-9220
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Country | US
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Telephone | 580-495-8789
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Fax |
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Provider Business Mailing Address
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Address Line | 9816 COUNTY ROAD 3579
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City | ADA
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State | OK
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Zip | 74820-4724
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Country | US
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Telephone | 918-752-8989
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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 | 2681
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License Number State | OK
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