Healthcare Provider Details

I. General information

NPI: 1518239284
Provider Name (Legal Business Name): CYNTHIA DIANE PUCKETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY D PUCKETT OTR/L

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 NW 58TH ST STE 103
OKLAHOMA CITY OK
73118-5905
US

IV. Provider business mailing address

2521 RIDGE ESTATES DR
YUKON OK
73099-5070
US

V. Phone/Fax

Practice location:
  • Phone: 405-563-1236
  • Fax: 405-310-1877
Mailing address:
  • Phone: 405-550-3380
  • Fax: 405-310-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOT892
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT892
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT892
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT892
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT892
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT892
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: