MEDICARE: RELAND K HERMAN COTA/L

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	224Z00000X	Occupational Therapy Assistant	1552	OK

General Provider Information

NPI Number	:	1831789320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RELAND K HERMAN COTA/L

Provider Business Mailing Address
First Line	:	285 TURKEY CREEK RD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-8034
Country	:	US
Telephone Number	:	918-213-9588
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 STATE ST STE 200
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2528
Country	:	US
Telephone Number	:	918-213-9588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	01/19/2021

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