Individual
MR. DALE BRIAN MANGUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
6400 N SANTA FE AVE, SUITE B, OKLAHOMA CITY, OK 73116-9126
(405) 840-2903
Mailing address
229 W APPLE BRANCH WAY, MUSTANG, OK 73064-3810
(405) 361-9929
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA200
OK
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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