Provider Demographics
NPI:1225922149
Name:CHILDRESS-VIK, ANGEL LEE (OTA)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LEE
Last Name:CHILDRESS-VIK
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40550 N 4000 RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-6349
Mailing Address - Country:US
Mailing Address - Phone:918-948-4708
Mailing Address - Fax:
Practice Address - Street 1:2230 SE WASHINGTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7100
Practice Address - Country:US
Practice Address - Phone:918-533-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1497224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant