Provider Demographics
NPI:1447301577
Name:DOLLENS, CONSTANCE K (OT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:K
Last Name:DOLLENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:K
Other - Last Name:GEUBELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1017 E COMET PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4614
Mailing Address - Country:US
Mailing Address - Phone:918-695-4691
Mailing Address - Fax:
Practice Address - Street 1:1202 N MUSKOGEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3058
Practice Address - Country:US
Practice Address - Phone:918-342-6703
Practice Address - Fax:918-342-7889
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist