Provider Demographics
NPI:1508070210
Name:MCCORMICK, AMBER DAWNELL (COTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWNELL
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-0133
Mailing Address - Country:US
Mailing Address - Phone:405-542-6693
Mailing Address - Fax:
Practice Address - Street 1:800 N. ARAPAHO
Practice Address - Street 2:
Practice Address - City:HYDRO
Practice Address - State:OK
Practice Address - Zip Code:73048
Practice Address - Country:US
Practice Address - Phone:405-663-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant