Individual
MR. ALAN DWAYNE STATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
8720 S. 101ST AVE, TULSA, OK 74133
(918) 965-0101
Mailing address
412 E BEAVER ST, JENKS, OK 74037-4513
(918) 637-4790
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
OK
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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