Provider Demographics
NPI:1578385829
Name:DOTSON, SAVANNAH ROSE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:ROSE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GUNNER LOOP
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6634
Mailing Address - Country:US
Mailing Address - Phone:918-859-9301
Mailing Address - Fax:
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7602
Practice Address - Country:US
Practice Address - Phone:918-308-9847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist