Healthcare Provider Details

I. General information

NPI: 1134305840
Provider Name (Legal Business Name): JESSICA DAWN TSOTSOROS MS OTR/L ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 OAKRIDGE DR
BROKEN ARROW OK
74014-2729
US

IV. Provider business mailing address

7770 OAKRIDGE DR
BROKEN ARROW OK
74014-2729
US

V. Phone/Fax

Practice location:
  • Phone: 918-698-7461
  • Fax:
Mailing address:
  • Phone: 918-698-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1035
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: