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General NPI Number Information
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NPI Number | 1295454379
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Entity Type | Organization
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Legal Business Name | LIFE AFTER CHILDBIRTH WITH OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1303 N 6TH AVE
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City | DURANT
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State | OK
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Zip | 74701-3339
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Country | US
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Telephone | 580-380-9413
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 N 6TH AVE
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City | DURANT
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State | OK
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Zip | 74701-3339
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Country | US
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Telephone | 580-380-9413
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | WESLINA JO MAXEY
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Credential |
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Telephone | 580-380-9413
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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 |
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License Number State |
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