Provider Demographics
NPI:1992453351
Name:REESE, JOSHUA (OTR)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 S ELM ST STE 111
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3653
Mailing Address - Country:US
Mailing Address - Phone:918-404-5066
Mailing Address - Fax:918-296-7121
Practice Address - Street 1:1605 S EUCALYPTUS AVE STE 200
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5996
Practice Address - Country:US
Practice Address - Phone:918-608-1212
Practice Address - Fax:918-289-2606
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist