Healthcare Provider Details

I. General information

NPI: 1336716554
Provider Name (Legal Business Name): RACHELLE WARD MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W IOLA ST
BROKEN ARROW OK
74012-2564
US

IV. Provider business mailing address

2488 E 81ST ST STE 290
TULSA OK
74137-4299
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-5333
  • Fax: 918-927-3201
Mailing address:
  • Phone: 918-927-3199
  • Fax: 918-927-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5568
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: