Provider Demographics
NPI:1033579818
Name:HICKMAN, JANA LYN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LYN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1006
Mailing Address - Country:US
Mailing Address - Phone:405-612-9534
Mailing Address - Fax:
Practice Address - Street 1:510 SURREY LN
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1006
Practice Address - Country:US
Practice Address - Phone:405-612-9534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist