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NPI Code Detail

MEDICARE: ALYSHA KIECK COTA/L

MEDICARE: ALYSHA KIECK 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
1224Z00000XOccupational Therapy Assistant2550OK

General Provider Information

NPI Number : 1932884897
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSHA KIECK COTA/L
Provider Business Mailing Address
First Line : 9900 S 4103 RD
Second Line :
City : OOLOGAH
State : OK
Zip : 74053-6270
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14002 E 21ST ST STE 650
Second Line :
City : TULSA
State : OK
Zip : 74134-1432
Country : US
Telephone Number : 918-274-7902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 12/12/2023

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Directions to “ ALYSHA KIECK COTA/L” Practice Location

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