Individual
MRS. STACEY RENEE WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4350 WILL ROGERS PKWY, SUITE 600, OKLAHOMA CITY, OK 73108-1826
(405) 246-6674
Mailing address
19165 S 4210 RD, CLAREMORE, OK 74019-4290
(918) 231-1758
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
434
OK
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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