Healthcare Provider Details

I. General information

NPI: 1558607804
Provider Name (Legal Business Name): KARI DAWN TANNER MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI DAWN TANNER COTA/L

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW
MIAMI OK
74354-6743
US

IV. Provider business mailing address

16412 S 4415 RD
BLUEJACKET OK
74333-4341
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7736
  • Fax: 918-540-7739
Mailing address:
  • Phone: 918-704-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1072
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6011
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: