Healthcare Provider Details

I. General information

NPI: 1881484715
Provider Name (Legal Business Name): ABC OCCUPATIONAL THERAPY CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 NE 1213 AVE
WISTER OK
74566
US

IV. Provider business mailing address

PO BOX 11
FANSHAWE OK
74935-0011
US

V. Phone/Fax

Practice location:
  • Phone: 918-413-4758
  • Fax:
Mailing address:
  • Phone: 918-413-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEAH D MONTGOMERY
Title or Position: OWNER
Credential: COTA/L
Phone: 918-413-4758