Individual
STACIE PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1003 N OKMULGEE AVE, OKMULGEE, OK 74447-2502
(918) 758-2030
Mailing address
205 VALHALLA DR, MUSKOGEE, OK 74403-8509
(918) 348-1779
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
610
OK
225X00000X
Occupational Therapist
Primary
5695
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200972050B
—
OK
Enumeration date
04/26/2016
Last updated
10/31/2022
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