Provider Demographics
NPI:1356030373
Name:CHALK, JOSIE
Entity type:Individual
Prefix:MRS
First Name:JOSIE
Middle Name:
Last Name:CHALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2128
Mailing Address - Country:US
Mailing Address - Phone:580-740-0205
Mailing Address - Fax:
Practice Address - Street 1:1600 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3094
Practice Address - Country:US
Practice Address - Phone:580-740-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1964224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant