Individual
FONTANA LOCUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
700 W SHAWNTEL SMITH BLVD, MULDROW, OK 74948-4013
(918) 427-7406
Mailing address
1635 KINGS WAY, ALMA, AR 72921-5144
(479) 430-0497
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
02/22/2018
Last updated
03/17/2018
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