=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902982200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEATRICE ERIKA RYAN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7112 S MINGO RD SUITE 108
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-250-7093
-----------------------------------------------------
Fax | 918-250-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11765 S CANTON AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137-8403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-369-9373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 1410
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------