Provider Demographics
NPI:1861047052
Name:DI LONARDO, MONIQUE MARIE (CTRS/L)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:DI LONARDO
Suffix:
Gender:F
Credentials:CTRS/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9526 S 95TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6163
Mailing Address - Country:US
Mailing Address - Phone:918-289-5965
Mailing Address - Fax:
Practice Address - Street 1:9526 S 95TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6163
Practice Address - Country:US
Practice Address - Phone:918-289-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist