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General NPI Number Information
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NPI Number | 1144550419
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Entity Type | Individual
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Provider Name | JENNIFER ELAINA PATE MOT/L, CLT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3125 W WILSHIRE BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-3131
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Country | US
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Telephone | 405-343-9027
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Fax |
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Provider Business Mailing Address
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Address Line | 3112 NW 171ST TER
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City | EDMOND
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State | OK
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Zip | 73012-0620
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Country | US
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Telephone | 940-859-4752
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 1560
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 113223
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License Number State | TX
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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 | 1560
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License Number State | OK
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