Individual
MRS. SHELLI DIANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
12899 E 76TH ST N, OWASSO, OK 74055-4021
(918) 272-1039
Mailing address
PO BOX 4408, TULSA, OK 74159-0408
(918) 272-1039
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1655
OK
Other
Enumeration date
12/22/2014
Last updated
12/22/2014
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