Provider Demographics
NPI:1740694512
Name:BARBER, RYAN LAKE (COTA/L)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:LAKE
Last Name:BARBER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S DUCK ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3249
Mailing Address - Country:US
Mailing Address - Phone:405-377-8255
Mailing Address - Fax:405-835-3920
Practice Address - Street 1:301 S DUCK ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3249
Practice Address - Country:US
Practice Address - Phone:405-377-8255
Practice Address - Fax:405-835-3920
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2157224Z00000X
TX211456224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty