Healthcare Provider Details

I. General information

NPI: 1154477057
Provider Name (Legal Business Name): MARLENE S SNOW OTR/L, MS, SCLV, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18433 SIERRA LN
NEWALLA OK
74857-8449
US

IV. Provider business mailing address

18433 SIERRA LN
NEWALLA OK
74857-8449
US

V. Phone/Fax

Practice location:
  • Phone: 405-391-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21801092
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOT802
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number802
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number802
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: