Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OA2378 | OK |
NPI | 1003567272 |
---|---|
Provider Name | Sydney Lane |
First Address | Oklahoma City, OK 73162-1860 |
Second Address | Oklahoma City, OK 73162-1860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2022 |
Last Update Date | 10/01/2022 |