Provider Demographics
NPI:1770319980
Name:WOLLET, REBECCA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WOLLET
Suffix:
Gender:F
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 1:123 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4603
Mailing Address - Country:US
Mailing Address - Phone:918-938-0887
Mailing Address - Fax:918-938-0684
Practice Address - Street 1:123 E 6TH STREET
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4603
Practice Address - Country:US
Practice Address - Phone:918-938-0887
Practice Address - Fax:918-938-0684
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2639224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant