Individual
HALEY BROOKE ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5301 N BROOKLINE AVE, OKLAHOMA CITY, OK 73112-3516
(405) 601-7874
Mailing address
12601 QUARTZ PL, OKLAHOMA CITY, OK 73170-5467
(405) 922-5998
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1736
OK
Other
Enumeration date
10/31/2017
Last updated
10/31/2017
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