Individual
MRS. PAULETTE AUDIE MARIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
12095 S ELM ST, JENKS, OK 74037-3689
(918) 808-9749
Mailing address
921 N FIR ST, JENKS, OK 74037-2705
(918) 200-4992
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1178
OK
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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