Provider Demographics
NPI:1902482334
Name:CAPRA, JADE NICOLE (MOT)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:CAPRA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5632
Mailing Address - Country:US
Mailing Address - Phone:580-366-7000
Mailing Address - Fax:580-366-8900
Practice Address - Street 1:500 S INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5632
Practice Address - Country:US
Practice Address - Phone:580-366-7000
Practice Address - Fax:580-366-8900
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist