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NPI Code Detail

MEDICARE: MRS. TERYL A SPERLE O.T.

MEDICARE: MRS. TERYL A SPERLE O.T.
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 Therapist195OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932395456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERYL A SPERLE O.T.
Provider Business Mailing Address
First Line : 2221 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3628
Country : US
Telephone Number : 918-615-6492
Fax Number : 918-615-6493
Provider Business Practice Location Address
First Line : 2221 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3628
Country : US
Telephone Number : 918-615-6492
Fax Number : 918-615-6493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 06/03/2010

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