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General NPI Number Information
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NPI Number | 1831789460
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Entity Type | Individual
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Provider Name | MARY DODGEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1401 SW 34TH ST
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City | MOORE
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State | OK
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Zip | 73160-3059
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Country | US
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Telephone | 405-793-7885
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Fax |
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Provider Business Mailing Address
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Address Line | 15034 CEDAR RIDGE RD
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City | SHAWNEE
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State | OK
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Zip | 74801-2501
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Country | US
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Telephone | 405-650-9074
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6038
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License Number State | OK
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