Provider Demographics
NPI:1255845442
Name:REDING, EVELYN JESSIE (COTA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:JESSIE
Last Name:REDING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 E SKELLY DR STE 402
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6441
Mailing Address - Country:US
Mailing Address - Phone:405-837-1059
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DR STE 402
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6441
Practice Address - Country:US
Practice Address - Phone:918-497-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK351224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant