Individual
MRS. BONNIE SUE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1425 S SANTA FE AVE, SUITE E, EDMOND, OK 73003-5901
(405) 285-8845
(405) 285-8848
Mailing address
700 NW 7TH ST, SUITE 302, OKLAHOMA CITY, OK 73102-1212
(405) 609-3675
(800) 506-3795
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1070
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200286380A
—
OK
Enumeration date
05/05/2010
Last updated
08/27/2012
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