Provider Demographics
NPI:1629494000
Name:SCHAFER, LEE ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:SCHAFER
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 1:1027 E 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-1349
Mailing Address - Country:US
Mailing Address - Phone:918-527-5330
Mailing Address - Fax:
Practice Address - Street 1:1027 E 66TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-1349
Practice Address - Country:US
Practice Address - Phone:918-527-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14752083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine