Healthcare Provider Details

I. General information

NPI: 1952010258
Provider Name (Legal Business Name): TOAN NGUYEN OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 WESTPORT DR
NORMAN OK
73069-6337
US

IV. Provider business mailing address

2429 WESTPORT DR
NORMAN OK
73069-6337
US

V. Phone/Fax

Practice location:
  • Phone: 405-314-9345
  • Fax:
Mailing address:
  • Phone: 405-314-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5737
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: