Provider Demographics
NPI:1730772336
Name:SILK, MCKENNA (COTA/L)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:SILK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-8321
Mailing Address - Country:US
Mailing Address - Phone:580-661-3517
Mailing Address - Fax:580-846-0017
Practice Address - Street 1:118 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-8321
Practice Address - Country:US
Practice Address - Phone:580-661-3517
Practice Address - Fax:580-846-0017
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1819224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty