Provider Demographics
NPI:1063148468
Name:PETTY, BRIANNA N (COTA/L)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:PETTY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:N
Other - Last Name:SOUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 S COLTRANE RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6729
Mailing Address - Country:US
Mailing Address - Phone:580-318-9415
Mailing Address - Fax:
Practice Address - Street 1:501 S COLTRANE RD STE A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6729
Practice Address - Country:US
Practice Address - Phone:580-318-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2426224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant