Individual
TIM HENSLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1601 ACADEMY ROAD, PONCA CITY, OK 74604
(580) 749-5923
Mailing address
RT 1 BOX 18540, PORUM, OK 74455
(918) 817-9828
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
114
OK
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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