Healthcare Provider Details

I. General information

NPI: 1790242196
Provider Name (Legal Business Name): RENAE NICOLE MILLER MSOT, OTD OTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 06/10/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON ST
LAWTON OK
73503-4472
US

IV. Provider business mailing address

4301 WILSON ST
LAWTON OK
73503-4472
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-2000
  • Fax:
Mailing address:
  • Phone: 910-922-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: