Individual
MRS. BREANNA DAWN STICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6400 N. SANTA FE, SUITE B, OKC, OK 73116-9111
(405) 840-2903
(405) 840-3256
Mailing address
PO BOX 6642, MOORE, OK 73153-0642
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
956
OK
Other
Enumeration date
06/01/2011
Last updated
06/02/2011
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