Provider Demographics
NPI:1467699009
Name:PETERS, CAROL LYNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:PETERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:YURGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:715 N BREWER ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1426
Mailing Address - Country:US
Mailing Address - Phone:918-256-9207
Mailing Address - Fax:918-256-9209
Practice Address - Street 1:715 N BREWER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1426
Practice Address - Country:US
Practice Address - Phone:918-256-9207
Practice Address - Fax:918-256-9209
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA81224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant