Provider Demographics
NPI:1568666295
Name:ENDERS, CAROL J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:J
Last Name:ENDERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 N 14TH PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9293
Mailing Address - Country:US
Mailing Address - Phone:918-760-3141
Mailing Address - Fax:918-355-2767
Practice Address - Street 1:2404 N 14TH PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9293
Practice Address - Country:US
Practice Address - Phone:918-760-3141
Practice Address - Fax:918-355-2767
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist