Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 586 | OK |
NPI | 1033390448 |
---|---|
Provider Name | Ms. Marilyn Joyce Avery |
First Address | Tulsa, OK 74105-3224 |
Second Address | Broken Arrow, OK 74012-4519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 14/11/2007 |