Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Raymond M Wallace, COTA/L

Individual provider Occupational Therapy Assistant · NPI 1003490228

Raymond M Wallace, COTA/L is an Occupational Therapy Assistant in Broken Arrow, Oklahoma. Practices as a sole proprietor. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2021
What do these letters mean?
COTA/L — Certified Occupational Therapy Assistant, Licensed
An occupational therapy assistant who is both certified and state licensed.

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Practice location Address checks out

6956 S 310th East Ave
Broken Arrow, OK 74014-5491
Phone: (918) 230-8099
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence 569 (OK)

Record details

NPI number1003490228
Entity typeIndividual (Type 1)
GenderMale
Credentials COTA/L
Sole proprietorYes
NPI enumeratedMay 12, 2021
Last updated in NPPESMay 12, 2021
Certification dateMay 12, 2021

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