Provider Demographics
NPI:1578282000
Name:DILLDINE, CORINNE NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:NICOLE
Last Name:DILLDINE
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 1:204 S 197TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74108-7926
Mailing Address - Country:US
Mailing Address - Phone:918-850-0904
Mailing Address - Fax:
Practice Address - Street 1:204 S 197TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74108-7926
Practice Address - Country:US
Practice Address - Phone:918-850-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2446224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant