Latara Easton Blankenship
Individual provider Active NPI Occupational Therapy Assistant · Shawnee, OK
NPI 1043809130 · NPPES record last updated Jan 13, 2021
Key facts
- NPI
- 1043809130
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2224 (OK)
- Practice address
- 3903 N Harrison St
Shawnee, OK 74804-1426 - Phone
- (405) 585-2971
- Fax
- (405) 585-2983
- NPI assigned
- Jan 13, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2224 | OK | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2224 | OK | Yes |
Addresses
Primary practice location
3903 N Harrison St
Shawnee, OK 74804-1426
Mailing address
1205 N Market Ave
Shawnee, OK 74801-4923
Phone (580) 791-1005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2224 | Other | OK | STATE LICENSE |
Other providers in Shawnee, OK
- Richard Blackburn
- Morgan Blackstock
- Davi Blackthorne
- Kalob Michael Blackwell
- Wanda A Blackwell
- Samantha Blankenship
- Kylie Makenzie Blas
- Hayden Blessing
- Emily Blythe
- Shelby Noelle Bodine
All providers in Shawnee, OK · Occupational Therapy Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.