MEDICARE: MAKINA JANE TOMLINSON OT

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	225XP0019X	Physical Rehabilitation Occupational Therapist	5312	OK

General Provider Information

NPI Number	:	1407328628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKINA JANE TOMLINSON OT

Provider Business Mailing Address
First Line	:	6800 S GRANITE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7039
Country	:	US
Telephone Number	:	417-489-2881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2257 W WASHINGTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6703
Country	:	US
Telephone Number	:	918-994-7799
Fax Number	:

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

Provider Enumeration Date	:	12/28/2018
Last Update Date	:	07/31/2023

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