Individual
NICOLE WHITLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4101 NW 122ND ST, OKLAHOMA CITY, OK 73120-8800
(405) 562-9260
Mailing address
3009 SW 139TH ST, OKLAHOMA CITY, OK 73170-5708
(405) 651-4070
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1505
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
OK
Enumeration date
10/20/2014
Last updated
10/20/2014
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