Provider Demographics
NPI:1902320310
Name:BURKDOLL, MEGAN MARIE (OT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:BURKDOLL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:WINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4299
Mailing Address - Country:US
Mailing Address - Phone:918-494-2665
Mailing Address - Fax:918-927-3193
Practice Address - Street 1:1071 W BLUE STARR DR STE 105
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2869
Practice Address - Country:US
Practice Address - Phone:918-283-2992
Practice Address - Fax:918-927-3201
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist