MEDICARE: MRS. ANGEL LEE CHILDRESS-VIK OTA

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	224Z00000X	Occupational Therapy Assistant	1497	OK

General Provider Information

NPI Number	:	1225922149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGEL LEE CHILDRESS-VIK OTA

Provider Business Mailing Address
First Line	:	40550 N 4000 RD
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-6349
Country	:	US
Telephone Number	:	918-948-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 SE WASHINGTON BLVD STE 104
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-7100
Country	:	US
Telephone Number	:	918-533-1122
Fax Number	:

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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Directions to “ MRS. ANGEL LEE CHILDRESS-VIK OTA” Practice Location

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