Healthcare Provider Details

I. General information

NPI: 1679046668
Provider Name (Legal Business Name): LORI SCHWAB COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 N BROOKLINE AVE
OKLAHOMA CITY OK
73112-3516
US

IV. Provider business mailing address

1716 DENA DR
EDMOND OK
73003-3758
US

V. Phone/Fax

Practice location:
  • Phone: 405-251-2847
  • Fax:
Mailing address:
  • Phone: 405-818-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1955
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: