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NPI Code Detail

MEDICARE: AVERY DRU CARLS

MEDICARE: AVERY DRU CARLS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant2675OK

General Provider Information

NPI Number : 1861369407
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY DRU CARLS
Provider Business Mailing Address
First Line : 81552 N 2595 RD
Second Line :
City : WATONGA
State : OK
Zip : 73772-7205
Country : US
Telephone Number : 580-216-5399
Fax Number :
Provider Business Practice Location Address
First Line : 501 S COLTRANE RD STE A
Second Line :
City : EDMOND
State : OK
Zip : 73034-6729
Country : US
Telephone Number : 580-318-9415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2025
Last Update Date : 04/14/2026

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Directions to “ AVERY DRU CARLS ” Practice Location

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