Provider Demographics
NPI:1326431776
Name:LAIL, HEIDI (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:LAIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12532 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2870
Mailing Address - Country:US
Mailing Address - Phone:918-995-2022
Mailing Address - Fax:
Practice Address - Street 1:5350 E 46TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6601
Practice Address - Country:US
Practice Address - Phone:918-660-6886
Practice Address - Fax:918-660-0874
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK576225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist