Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 33 | OK |
NPI | 1023607876 |
---|---|
Provider Name | Mrs. Patty S. Smith |
First Address | Norman, OK 73072-5858 |
Second Address | Norman, OK 73072-5858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2021 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33 | OK LICENSE (01) | OK |