MEDICARE: COTTONWOOD PUBLIC SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1609847573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD PUBLIC SCHOOL

Provider Business Mailing Address
First Line	:	PO BOX 347
Second Line	:
City	:	COALGATE
State	:	OK
Zip	:	74538-0347
Country	:	US
Telephone Number	:	580-927-2937
Fax Number	:	580-927-2938

Provider Business Practice Location Address
First Line	:	LUBBIS ST
Second Line	:	2 MI NE OF COALGATE OK ON STATE HWY 31
City	:	COTTONWOOD
State	:	OK
Zip	:	74538-0347
Country	:	US
Telephone Number	:	580-927-2937
Fax Number	:	580-927-2938

Authorized Official
Title or Position	:	SCHOOL SUPERINTENDENT
Name	:	MRS. TERI BRECHEEN
Credential	:
Telephone Number	:	580-927-2937

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/22/2020

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Directions to “COTTONWOOD PUBLIC SCHOOL ” Practice Location

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