Justin Black – Occupational Therapy Assistant

Key facts

NPI: 1245969138
Entity type: Individual (NPI type 1)
Primary specialty: Occupational Therapy Assistant 224Z00000X
License: 1513 (OK)
Practice address: 508 E Wilson St
Valliant, OK 74764-9115
Phone: (580) 743-6553
NPI assigned: Jun 7, 2022
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Speech Therapy for SE Oklahoma LLC Speech-Language Pathologist · Valliant, OK · NPI 1336713825

NPD OCCUPATIONAL THERAPY ASSISTANT

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
1513	OK	MD	Occupational Therapy Assistant

Practice roles

Organization	Specialty	Status	New patients
Speech Therapy for SE Oklahoma LLC	Occupational Therapy Assistant	Current since Jun 12, 2022	Accepting new patients

Locations

508 E Wilson St
Valliant, OK 74764
Phone (580) 743-6553

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Occupational Therapy Assistant	224Z00000X	1513	OK	Yes

Addresses

Primary practice location

508 E Wilson St
Valliant, OK 74764-9115

Mailing address

404 Allen St
Broken Bow, OK 74728-3136
Phone (580) 306-4747

Other providers in Valliant, OK

All providers in Valliant, 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 Jun 7, 2022. 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.

Verify at the official NPI Registry.