Provider Demographics
NPI:1487772117
Name:WALES, TAMARA PATOCKA (OT)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:PATOCKA
Last Name:WALES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2083
Mailing Address - Country:US
Mailing Address - Phone:405-707-0779
Mailing Address - Fax:
Practice Address - Street 1:120 N PERKINS RD STE F
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5524
Practice Address - Country:US
Practice Address - Phone:405-564-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist