Individual
ANTHONY MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
729 SW 40TH, OKLAHOMA, OK 73109
(405) 802-5291
Mailing address
1205 KINGSTON BLVD, EDMOND, OK 73034-3227
(580) 318-9415
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2274
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062021131991010219
—
OK
Enumeration date
09/12/2022
Last updated
09/12/2022
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