Basic Information
| Provider Information | |||||||||
| NPI: | 1194742056 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SEN | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 W WILL ROGERS BLVD | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183423800 | ||||||||
| FaxNumber: | 9183423900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 N SIOUX ST | ||||||||
| Address2: | STE C | ||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183423800 | ||||||||
| FaxNumber: | 9183423900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1245 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 200083510A | 05 | OK | MEDICAID |