Provider Demographics
NPI:1063275832
Name:ZIMMERMAN, VICKY KAY (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:KAY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:VICKY
Other - Middle Name:KAY
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:9505 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2022
Mailing Address - Country:US
Mailing Address - Phone:405-503-5458
Mailing Address - Fax:
Practice Address - Street 1:9505 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-2022
Practice Address - Country:US
Practice Address - Phone:405-503-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA238224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant