Individual
OU-KHAM CHANSOMBATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
309 SW 59TH ST STE 305, OKLAHOMA CITY, OK 73109-8324
(405) 355-3239
Mailing address
613 WESTWOOD DR, OKLAHOMA CITY, OK 73127-4835
(405) 408-1437
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1308
OK
Other
Enumeration date
08/06/2022
Last updated
08/06/2022
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