Provider Demographics
NPI:1316617145
Name:LITZINGER, MARY MADELINE (OT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MADELINE
Last Name:LITZINGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MADELINE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7608 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6014
Mailing Address - Country:US
Mailing Address - Phone:918-663-0606
Mailing Address - Fax:
Practice Address - Street 1:7608 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6014
Practice Address - Country:US
Practice Address - Phone:918-663-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist