Provider Demographics
NPI:1487365417
Name:STILLS, AUSTYN HALEY
Entity type:Individual
Prefix:
First Name:AUSTYN
Middle Name:HALEY
Last Name:STILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUSTYN
Other - Middle Name:HALEY
Other - Last Name:OTTERBINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4814 OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1473
Mailing Address - Country:US
Mailing Address - Phone:918-310-6556
Mailing Address - Fax:
Practice Address - Street 1:1805 N YORK ST STE H
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1442
Practice Address - Country:US
Practice Address - Phone:918-912-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant