Healthcare Provider Details

I. General information

NPI: 1710270913
Provider Name (Legal Business Name): CASSIE S COOPER-RODKEY OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STONEWALL AVE RM. 1082
OKLAHOMA CITY OK
73117-1215
US

IV. Provider business mailing address

5986 S YALE AVE
TULSA OK
74135-7414
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2866
  • Fax:
Mailing address:
  • Phone: 918-344-4011
  • Fax: 918-344-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT473
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: