Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2168 | OK |
NPI | 1023607033 |
---|---|
Provider Name | Stephanie Spencer |
First Address | Tulsa, OK 74133-3634 |
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 |