Healthcare Provider Details

I. General information

NPI: 1548721418
Provider Name (Legal Business Name): TIFFANY BROOKE ADAMS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
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

5301 N BROOKLINE AVE
OKLAHOMA CITY OK
73112-3516
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5321
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: