Provider Demographics
NPI:1265878748
Name:DUNCANSON, CHERYL (COTA)
Entity type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:
Last Name:DUNCANSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 S POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7550
Mailing Address - Country:US
Mailing Address - Phone:918-455-8139
Mailing Address - Fax:
Practice Address - Street 1:3105 S POPLAR AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7550
Practice Address - Country:US
Practice Address - Phone:918-455-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist