Provider Demographics
NPI:1487202677
Name:RHOADES, JANE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:RHOADES
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 1:412 N BROADWAY AVE # 416
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6922
Mailing Address - Country:US
Mailing Address - Phone:405-273-1523
Mailing Address - Fax:
Practice Address - Street 1:412 N BROADWAY AVE # 416
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6922
Practice Address - Country:US
Practice Address - Phone:405-273-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2064224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant