Healthcare Provider Details

I. General information

NPI: 1093632085
Provider Name (Legal Business Name): AUBREY MAREE CLEMENS OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 14TH ST STE 104
TULSA OK
74104-4441
US

IV. Provider business mailing address

2704 W OCALA ST
BROKEN ARROW OK
74011-4509
US

V. Phone/Fax

Practice location:
  • Phone: 918-982-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3001
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: