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NPI Code Detail

MEDICARE: SHANNON TUBB OTR/L

MEDICARE: SHANNON TUBB 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 Therapist1607OK

General Provider Information

NPI Number : 1710331608
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON TUBB OTR/L
Provider Business Mailing Address
First Line : 2692 N WILD MOUNTAIN RD
Second Line :
City : TULSA
State : OK
Zip : 74127-1100
Country : US
Telephone Number : 918-810-9584
Fax Number :
Provider Business Practice Location Address
First Line : 2692 N WILD MOUNTAIN RD
Second Line :
City : TULSA
State : OK
Zip : 74127-1100
Country : US
Telephone Number : 918-810-9584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2016
Last Update Date : 04/18/2016

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Directions to “ SHANNON TUBB OTR/L” Practice Location

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