MEDICARE: MARY MARGARET SUMNER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1896	OK

General Provider Information

NPI Number	:	1093177057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MARGARET SUMNER OTR/L

Provider Business Mailing Address
First Line	:	200 NW 66TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-8256
Country	:	US
Telephone Number	:	405-840-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NW 66TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-8256
Country	:	US
Telephone Number	:	405-840-1957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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