Provider Demographics
NPI:1124730981
Name:RUYLE, MATTHEW AARON (COTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:RUYLE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 E 5TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-2909
Mailing Address - Country:US
Mailing Address - Phone:918-899-4547
Mailing Address - Fax:
Practice Address - Street 1:1605 S EUCALYPTUS AVE STE 200
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5996
Practice Address - Country:US
Practice Address - Phone:918-608-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2443224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant