Healthcare Provider Details

I. General information

NPI: 1821116500
Provider Name (Legal Business Name): MS. TANIA M DEGIUSTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 N MORGAN RD
TUTTLE OK
73089-8355
US

IV. Provider business mailing address

1514 N MORGAN RD
TUTTLE OK
73089-8355
US

V. Phone/Fax

Practice location:
  • Phone: 405-473-9524
  • Fax:
Mailing address:
  • Phone: 405-473-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number898
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: