Individual
TESSA ELLYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
40289 CITIZEN PLACE NORTH RD, SHAWNEE, OK 74801-3701
(405) 201-2079
Mailing address
40289 CITIZEN PLACE NORTH RD, SHAWNEE, OK 74801-3701
(405) 201-2079
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
518
OK
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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