Provider Demographics
NPI:1144061003
Name:PORTERFIELD, JASON P (OTR/L)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:PORTERFIELD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:P
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5401 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2026
Mailing Address - Country:US
Mailing Address - Phone:405-384-5250
Mailing Address - Fax:
Practice Address - Street 1:5401 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2026
Practice Address - Country:US
Practice Address - Phone:405-384-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5868225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist