Provider Demographics
NPI:1518239284
Name:PUCKETT, CYNTHIA DIANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:D
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2521 RIDGE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5070
Mailing Address - Country:US
Mailing Address - Phone:405-550-3380
Mailing Address - Fax:405-310-1877
Practice Address - Street 1:924 NW 58TH ST STE 103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5905
Practice Address - Country:US
Practice Address - Phone:405-563-1236
Practice Address - Fax:405-310-1877
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT892225XL0004X, 225XP0200X, 225XP0019X, 225X00000X
OT892225XF0002X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist