Provider Demographics
NPI:1750688081
Name:RUBINO, TABATHA M (COTA/L)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:M
Last Name:RUBINO
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 1:9777 N COUNCIL RD APT 1122
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5554
Mailing Address - Country:US
Mailing Address - Phone:405-640-8821
Mailing Address - Fax:405-470-7050
Practice Address - Street 1:6400 NORTH SANTE FE AVE
Practice Address - Street 2:STE. B
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73116-9111
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1156224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant