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General NPI Number Information
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NPI Number | 1730767658
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Entity Type | Individual
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Provider Name | ANGELICA BUTANDA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 5300 N MERIDIAN AVE STE 9A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2137
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Country | US
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Telephone | 405-410-8814
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Fax | 405-467-4552
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Provider Business Mailing Address
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Address Line | 1420 N REGATTA DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73127-9709
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Country | US
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Telephone |
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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 | 2091
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License Number State | OK
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