Provider Demographics
NPI:1619680378
Name:SLONE, SAMANTHA (COTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SLONE
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 1:4425 E 31ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2177
Mailing Address - Country:US
Mailing Address - Phone:918-212-4804
Mailing Address - Fax:844-438-5913
Practice Address - Street 1:4425 E 31ST ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2177
Practice Address - Country:US
Practice Address - Phone:918-212-4804
Practice Address - Fax:844-438-5913
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2448224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant