Provider Demographics
NPI:1922350420
Name:FERRELL, TIMMORI JADE (COTA)
Entity Type:Individual
Prefix:
First Name:TIMMORI
Middle Name:JADE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TIMMORI
Other - Middle Name:JADE
Other - Last Name:HEYDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:410 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3774
Mailing Address - Country:US
Mailing Address - Phone:580-237-1973
Mailing Address - Fax:
Practice Address - Street 1:410 N 30TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3774
Practice Address - Country:US
Practice Address - Phone:580-237-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA1325224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant