Provider Demographics
NPI:1578938288
Name:SMITH, MASON JAMES (OTR/L)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:OTR/L
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 41
Mailing Address - Street 2:
Mailing Address - City:BINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73009-0041
Mailing Address - Country:US
Mailing Address - Phone:405-545-0864
Mailing Address - Fax:
Practice Address - Street 1:311 WEST CEDAR STREET
Practice Address - Street 2:
Practice Address - City:BINGER
Practice Address - State:OK
Practice Address - Zip Code:73009-7300
Practice Address - Country:US
Practice Address - Phone:405-545-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5648225X00000X
TX212901224Z00000X
OK1541224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant