Individual
MANDY DEGIACOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
523 W MAIN ST, DURANT, OK 74701-5009
(580) 924-7700
Mailing address
523 W MAIN ST, DURANT, OK 74701-5009
(580) 924-7700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1370
OK
Other
Enumeration date
12/06/2014
Last updated
01/06/2015
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