Provider Demographics
NPI:1144550419
Name:PATE, JENNIFER ELAINA (MOT/L, CLT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELAINA
Last Name:PATE
Suffix:
Gender:F
Credentials:MOT/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 NW 171ST TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0620
Mailing Address - Country:US
Mailing Address - Phone:940-859-4752
Mailing Address - Fax:
Practice Address - Street 1:3125 W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3131
Practice Address - Country:US
Practice Address - Phone:405-343-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1560171W00000X, 225X00000X
TX113223171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor