Provider Demographics
NPI:1609467703
Name:WILLIAMSON, MISTY L (COTA/L)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:L
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5528
Mailing Address - Country:US
Mailing Address - Phone:918-259-5784
Mailing Address - Fax:918-251-0689
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5528
Practice Address - Country:US
Practice Address - Phone:918-259-5784
Practice Address - Fax:918-251-0689
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant