Provider Demographics
NPI:1497132856
Name:PETREE, TANYA LOREE (COTA/L)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LOREE
Last Name:PETREE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LOREE
Other - Last Name:PANCOAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5813 E 143RD PL S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4138
Mailing Address - Country:US
Mailing Address - Phone:405-706-7355
Mailing Address - Fax:
Practice Address - Street 1:5813 E 143RD PL S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4138
Practice Address - Country:US
Practice Address - Phone:405-706-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK515224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant