Individual
SURAYA LYNN MIKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 E 141ST ST, GLENPOOL, OK 74033-3807
(918) 291-4230
Mailing address
1202 E 57TH PL, TULSA, OK 74105-7815
(918) 808-4062
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
872
OK
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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