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General NPI Number Information
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NPI Number | 1275966194
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Entity Type | Individual
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Provider Name | JAIMIE LEIGH WARDLAW OTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 7617 NW 133RD PL
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-4451
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Country | US
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Telephone | 405-206-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 521 N 2ND ST
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City | OKEENE
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State | OK
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Zip | 73763-9369
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Country | US
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Telephone | 580-822-1585
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number | 1233
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License Number State | OK
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