Individual
MS. LYDIA NOEL HYSLOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1501 W GARY ST, BROKEN ARROW, OK 74012-6823
(918) 815-3704
Mailing address
1501 W GARY ST, BROKEN ARROW, OK 74012-6823
(918) 815-3704
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1479
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1479
CERTIFIED OCCUPATIONAL THERAPY ASSISTANT LICENSE
OK
Enumeration date
01/07/2017
Last updated
01/07/2017
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