Provider Demographics
NPI:1558171918
Name:ANTONIO, AMY PAOLA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:PAOLA
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 E MARSHALL PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-5930
Mailing Address - Country:US
Mailing Address - Phone:918-934-5703
Mailing Address - Fax:
Practice Address - Street 1:3650 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7623
Practice Address - Country:US
Practice Address - Phone:918-331-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant