Provider Demographics
NPI:1518239284
Name:PUCKETT, CYNTHIA DIANE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:D
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13130 CANYON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-7405
Mailing Address - Country:US
Mailing Address - Phone:405-550-3380
Mailing Address - Fax:
Practice Address - Street 1:13130 CANYON LAKES DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-7405
Practice Address - Country:US
Practice Address - Phone:405-550-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT892171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor