Provider Demographics
NPI:1417358987
Name:FERGUSON, AMY CATHLEEN (MOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHLEEN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41116 E COUNTY ROAD 1240
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-6451
Mailing Address - Country:US
Mailing Address - Phone:918-697-2909
Mailing Address - Fax:
Practice Address - Street 1:2300 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-962-0198
Practice Address - Fax:844-632-7298
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1904225X00000X
AROTR2724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200554810AMedicaid