Provider Demographics
NPI:1912729260
Name:FLEETWOOD, KAREN SUZETTE (COTA)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUZETTE
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:SUZETTE
Other - Last Name:HOLMZTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:6879 W OSAGE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-8797
Mailing Address - Country:US
Mailing Address - Phone:580-560-3296
Mailing Address - Fax:
Practice Address - Street 1:6879 W OSAGE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-8797
Practice Address - Country:US
Practice Address - Phone:580-560-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant