Individual
MRS. AVERY LAUREN BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1620 MIDTOWN PL, MIDWEST CITY, OK 73130-6347
(580) 641-2681
Mailing address
1620 MIDTOWN PL, MIDWEST CITY, OK 73130-6347
(580) 641-2681
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2034
OK
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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