Healthcare Provider Details

I. General information

NPI: 1477472322
Provider Name (Legal Business Name): TUCKER RHAY GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TUCKER RHAY WESLEY

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N MAIN ST
BRISTOW OK
74010-2015
US

IV. Provider business mailing address

3417 MCDONALD DR
BRISTOW OK
74010-2431
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-5555
  • Fax:
Mailing address:
  • Phone: 918-900-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: