Provider Demographics
NPI:1669682720
Name:BOCKELMAN, STACY ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:BOCKELMAN
Suffix:
Gender:F
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 1:217 N RAMBLIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7834
Mailing Address - Country:US
Mailing Address - Phone:405-799-2989
Mailing Address - Fax:
Practice Address - Street 1:4100 S DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3210
Practice Address - Country:US
Practice Address - Phone:405-644-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist