Provider Demographics
NPI:1659264935
Name:LETTE-FORTUNE, ELIZABETH MICHELLE (OT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:LETTE-FORTUNE
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 1:11729 ULLMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-8618
Mailing Address - Country:US
Mailing Address - Phone:580-319-2660
Mailing Address - Fax:
Practice Address - Street 1:1402 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1219
Practice Address - Country:US
Practice Address - Phone:580-850-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics