Provider Demographics
NPI:1295485076
Name:ROSALES, ADRIAN ESTEBAN (COTA/L)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ESTEBAN
Last Name:ROSALES
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 1:306 N CHISHOLM WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-1339
Mailing Address - Country:US
Mailing Address - Phone:405-510-7489
Mailing Address - Fax:
Practice Address - Street 1:1016 SW 44TH ST STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3617
Practice Address - Country:US
Practice Address - Phone:405-221-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2092224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant