Provider Demographics
NPI:1164815957
Name:SIMS, RYAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:LEA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13505 WINDING TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5723
Mailing Address - Country:US
Mailing Address - Phone:918-219-9322
Mailing Address - Fax:
Practice Address - Street 1:13505 WINDING TRAIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5723
Practice Address - Country:US
Practice Address - Phone:182-199-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007590225X00000X
OK1986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1986Medicaid