Provider Demographics
NPI:1699020487
Name:PEEPLES, MICHELLE R (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:PEEPLES
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 1:24105 S 4230 RD
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-5288
Mailing Address - Country:US
Mailing Address - Phone:918-855-8577
Mailing Address - Fax:
Practice Address - Street 1:6201 E 36TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5810
Practice Address - Country:US
Practice Address - Phone:918-622-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1111224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant