Healthcare Provider Details

I. General information

NPI: 1427393818
Provider Name (Legal Business Name): BENJAMIN STOLINSKI OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8506 E 61ST ST
TULSA OK
74133-1916
US

IV. Provider business mailing address

8506 E 61ST ST
TULSA OK
74133-1916
US

V. Phone/Fax

Practice location:
  • Phone: 918-357-4321
  • Fax: 918-357-6038
Mailing address:
  • Phone: 918-357-4321
  • Fax: 918-357-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA737
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1293
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5282
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: