Provider Demographics
NPI:1952993982
Name:ZOSCHKE, MEGHAN (COTA/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:ZOSCHKE
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:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-0818
Mailing Address - Country:US
Mailing Address - Phone:580-661-3517
Mailing Address - Fax:580-661-3528
Practice Address - Street 1:104 N MAIN
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669
Practice Address - Country:US
Practice Address - Phone:580-661-3517
Practice Address - Fax:580-661-3528
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1244224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant