Individual
MIMI MARY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 474-1474
Mailing address
2509 S HARVARD CT, APT 27A, TULSA, OK 74114-4626
(918) 748-4417
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1029
OK
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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