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1861069379
ALAN DWAYNE STATUM
TULSA, OK
NPI
1861069379
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
Enumeration Date
2021-06-04
Last Update Date
2021-06-04
Business Address
Mr. ALAN DWAYNE STATUM OTA
8720 S. 101ST AVE
TULSA, OK 74133
Phone number: 918-965-0101
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Mailing Address
Mr. ALAN DWAYNE STATUM OTA
412 E BEAVER ST
JENKS, OK 74037-4513
Phone number: 918-637-4790
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