Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2263 | OK |
NPI | 1003405143 |
---|---|
Provider Name | Maecie Dawn Smith |
First Address | Claremore, OK 74017-6513 |
Second Address | Tulsa, OK 74145-4520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2021 |
Last Update Date | 13/01/2021 |