Provider Demographics
NPI:1477267581
Name:FARBRO, DAELYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:DAELYN
Middle Name:
Last Name:FARBRO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22998 S 4400 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-5602
Mailing Address - Country:US
Mailing Address - Phone:918-244-1002
Mailing Address - Fax:
Practice Address - Street 1:402 W CLYDE AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2105
Practice Address - Country:US
Practice Address - Phone:918-256-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1726224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant