Provider Demographics
NPI:1528289634
Name:CONTOS, NANCY (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CONTOS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BRATTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:4301 NE MOSSY OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-4556
Mailing Address - Country:US
Mailing Address - Phone:301-332-8009
Mailing Address - Fax:580-670-7074
Practice Address - Street 1:6223 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:301-332-8009
Practice Address - Fax:580-670-7074
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1797225XP0200X
KYKY-R3628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200463190AMedicaid