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General NPI Number Information
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NPI Number | 1942409032
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Entity Type | Individual
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Provider Name | KRISTINE A SISK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 12899 E 76TH ST N UNIT NO117
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City | OWASSO
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State | OK
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Zip | 74055-4026
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Country | US
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Telephone | 918-269-4128
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Fax | 918-343-7491
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Provider Business Mailing Address
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Address Line | 12899 E 76TH ST N UNIT NO117
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City | OWASSO
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State | OK
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Zip | 74055-4026
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Country | US
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Telephone | 918-269-4128
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Fax | 918-343-7491
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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 | 735
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License Number State | OK
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