Provider Demographics
NPI:1821116500
Name:DEGIUSTI, TANIA M
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:M
Last Name:DEGIUSTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8355
Mailing Address - Country:US
Mailing Address - Phone:405-473-9524
Mailing Address - Fax:
Practice Address - Street 1:1514 N MORGAN RD
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8355
Practice Address - Country:US
Practice Address - Phone:405-473-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK898224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant