=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366138265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ELIZABETH STEWART OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2023
-----------------------------------------------------
Last Update Date | 07/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2401 NW 23RD ST STE 2D
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73107-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-940-5355
-----------------------------------------------------
Fax | 427-040-5212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2613 RICKS TRL
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73012-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-642-2108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5783
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------