Provider Demographics
NPI:1760459853
Name:BRONSTON, TAVA NANETTE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:TAVA
Middle Name:NANETTE
Last Name:BRONSTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:TAVA
Other - Middle Name:NANETTE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2544
Mailing Address - Country:US
Mailing Address - Phone:918-809-1526
Mailing Address - Fax:
Practice Address - Street 1:3001 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2544
Practice Address - Country:US
Practice Address - Phone:918-809-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist