Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 816 | OK |
NPI | 1003029794 |
---|---|
Provider Name | Shelly Ann Rapoport |
First Address | Yukon, OK 73099-3343 |
Second Address | Yukon, OK 73099-3343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |