Provider Demographics
NPI:1538747928
Name:ATTERBERRY, MEGAN ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:ATTERBERRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4010 W 104TH PL S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1912
Mailing Address - Country:US
Mailing Address - Phone:405-464-9041
Mailing Address - Fax:
Practice Address - Street 1:3312 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2029
Practice Address - Country:US
Practice Address - Phone:918-400-0089
Practice Address - Fax:539-430-0051
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1511224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant