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General NPI Number Information
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NPI Number | 1053829341
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Entity Type | Individual
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Provider Name | MYRA MARTHA DEMISSIE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/20/2018
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2401 NW 23RD ST STE 1C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-2420
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Country | US
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Telephone | 405-355-3239
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Fax |
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Provider Business Mailing Address
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Address Line | 928 NE 17TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-8408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5664
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119010519
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 07952
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17-04253
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT010001546
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License Number State | DC
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