Individual
LATARA EASTON BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3903 N HARRISON ST, SHAWNEE, OK 74804-1426
(405) 585-2971
(405) 585-2983
Mailing address
1205 N MARKET AVE, SHAWNEE, OK 74801-4923
(580) 791-1005
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2224
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2224
STATE LICENSE
OK
Enumeration date
01/13/2021
Last updated
01/13/2021
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