Provider Demographics
NPI:1376120386
Name:RAKESTRAW, JULIE MICHELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MICHELLE
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MICHELLE
Other - Last Name:RUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:933 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1401
Mailing Address - Country:US
Mailing Address - Phone:405-760-4999
Mailing Address - Fax:
Practice Address - Street 1:9221 HARMONY DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6255
Practice Address - Country:US
Practice Address - Phone:405-869-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA298224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant