Provider Demographics
NPI:1306190822
Name:COLLINS, JOSHUA (COTA/L)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 E 76TH ST N
Mailing Address - Street 2:109
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4021
Mailing Address - Country:US
Mailing Address - Phone:918-609-6003
Mailing Address - Fax:918-609-6002
Practice Address - Street 1:12899 E 76TH ST N
Practice Address - Street 2:109
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4021
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:918-609-6002
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1243224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant