Healthcare Provider Details

I. General information

NPI: 1144794835
Provider Name (Legal Business Name): HEATHER SEAY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 W DETROIT ST
BROKEN ARROW OK
74012-3628
US

IV. Provider business mailing address

2308 W PITTSBURG ST
BROKEN ARROW OK
74012-4731
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-6492
  • Fax:
Mailing address:
  • Phone: 918-615-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: