Healthcare Provider Details

I. General information

NPI: 1154910909
Provider Name (Legal Business Name): LAUREN E BERRY OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MCGEE DR STE 113
NORMAN OK
73072-5858
US

IV. Provider business mailing address

1009 CEDARCREST ST
NORMAN OK
73071-6876
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-7898
  • Fax: 405-366-0010
Mailing address:
  • Phone: 903-353-3207
  • Fax: 405-366-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2228
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: