Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 112664 | TX |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1489 | OK |
NPI | 1033386925 |
---|---|
Provider Name | Mrs. Summer Trook |
First Address | Bixby, OK 74008-3825 |
Second Address | Tulsa, OK 74112-6826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2008 |
Last Update Date | 18/03/2010 |