Provider Demographics
NPI:1013620020
Name:SISCO, CHELSEY HANNAH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:HANNAH
Last Name:SISCO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:HANNAH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 TIMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4256
Mailing Address - Country:US
Mailing Address - Phone:320-241-3695
Mailing Address - Fax:
Practice Address - Street 1:4801 INTEGRIS PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist