Individual
MRS. JORDAN MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5000
Mailing address
809 ROSEHAVEN DR, ALTUS, OK 73521-4923
(580) 471-8292
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1793
OK
Other
Enumeration date
11/17/2016
Last updated
11/17/2016
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