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General NPI Number Information
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NPI Number | 1225922149
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Entity Type | Individual
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Provider Name | ANGEL LEE CHILDRESS-VIK OTA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2230 SE WASHINGTON BLVD STE 104
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City | BARTLESVILLE
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State | OK
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Zip | 74006-7100
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Country | US
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Telephone | 918-533-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 40550 N 4000 RD
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City | COLLINSVILLE
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State | OK
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Zip | 74021-6349
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Country | US
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Telephone | 918-948-4708
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1497
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License Number State | OK
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