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NPI Code Detail

MEDICARE: MS. STACY ANN BOCKELMAN OTR/L

MEDICARE: MS. STACY ANN BOCKELMAN 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
1225X00000XOccupational Therapist1547OK

General Provider Information

NPI Number : 1669682720
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACY ANN BOCKELMAN OTR/L
Provider Business Mailing Address
First Line : 217 N RAMBLIN OAKS DR
Second Line :
City : MOORE
State : OK
Zip : 73160-7834
Country : US
Telephone Number : 405-799-2989
Fax Number :
Provider Business Practice Location Address
First Line : 4100 S DOUGLAS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3210
Country : US
Telephone Number : 405-644-5182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/06/2016

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