Individual
RAYVIN NICOLE HACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
123 E 6TH ST, OKMULGEE, OK 74447-4603
(918) 938-0887
(918) 938-0684
Mailing address
123 E 6TH ST, OKMULGEE, OK 74447-4603
(918) 938-0887
(918) 938-0684
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2628
OK
Other
Enumeration date
06/07/2024
Last updated
06/24/2024
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