Healthcare Provider Details

I. General information

NPI: 1407328628
Provider Name (Legal Business Name): MAKINA JANE TOMLINSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 W WASHINGTON ST
BROKEN ARROW OK
74012-6703
US

IV. Provider business mailing address

6800 S GRANITE AVE
TULSA OK
74136-7039
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-7799
  • Fax:
Mailing address:
  • Phone: 417-489-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5312
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: