Provider Demographics
NPI:1831788645
Name:WADE, BRANDY LYNNE (COTA/L)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNNE
Last Name:WADE
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 1:430 NW 12TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3736
Mailing Address - Country:US
Mailing Address - Phone:918-759-8303
Mailing Address - Fax:
Practice Address - Street 1:2000 168TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-9010
Practice Address - Country:US
Practice Address - Phone:405-579-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2025-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2009OtherLICENSE