Healthcare Provider Details

I. General information

NPI: 1861759938
Provider Name (Legal Business Name): MOLLY COOK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY TOBEN OT

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 S 109TH EAST AVE STE 100
TULSA OK
74146
US

IV. Provider business mailing address

4808 S 109TH EAST AVE STE 100
TULSA OK
74146-5822
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-1482
  • Fax: 918-392-7063
Mailing address:
  • Phone: 918-392-1482
  • Fax: 918-392-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: