Individual
SONJA K MANGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT,OTR/L
Contact information
Practice address
15600 ACACIA RD, OKLAHOMA CITY, OK 73170-9313
(405) 664-0586
(405) 735-6984
Mailing address
15600 ACACIA RD, OKLAHOMA CITY, OK 73170-9313
(405) 664-0586
(866) 435-3297
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1373
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200028630A
—
OK
Enumeration date
09/20/2006
Last updated
02/11/2014
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