Individual
SHELBY NICOLE MONDLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA/L
Contact information
Practice address
4300 S JUNIPER PL, BROKEN ARROW, OK 74011-2832
(918) 259-4420
Mailing address
14206 S WINSTON AVE, BIXBY, OK 74008-3773
(918) 688-4205
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1211
OK
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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