Healthcare Provider Details

I. General information

NPI: 1245676923
Provider Name (Legal Business Name): SHERRIE BOREN OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 S ROSS AVE
OKLAHOMA CITY OK
73159
US

IV. Provider business mailing address

307 HANNAH DRIVE
TUTTLE OK
73089
US

V. Phone/Fax

Practice location:
  • Phone: 405-685-4791
  • Fax:
Mailing address:
  • Phone: 405-818-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1097
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: