Healthcare Provider Details

I. General information

NPI: 1518422377
Provider Name (Legal Business Name): MARIE REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date: 08/14/2024
Reactivation Date: 08/27/2024

III. Provider practice location address

1201 W BOYD ST
NORMAN OK
73069-4801
US

IV. Provider business mailing address

1201 W BOYD ST
NORMAN OK
73069-4801
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5980
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: