Individual
JAVIER IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1414 SW 89TH ST STE A, OKLAHOMA CITY, OK 73159-6312
(405) 703-8424
Mailing address
1414 SW 89TH ST STE A, OKLAHOMA CITY, OK 73159-6312
(405) 703-8424
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2096
OK
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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