Provider Demographics
NPI:1225564974
Name:CORLEY, ANITA GAIL (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:GAIL
Last Name:CORLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:GAIL
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:6024 S 92ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8318
Mailing Address - Country:US
Mailing Address - Phone:918-706-2488
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6471
Practice Address - Country:US
Practice Address - Phone:918-984-4408
Practice Address - Fax:888-317-1069
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK498224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant