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Oklahoma Board of Medical Licensure and Supervision

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PETERSEN, DONITA L       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: SELF-EMPLOYED
5622 N. PORTLAND #250
OKLAHOMA CITY OK 73112

Address last updated on 1/17/2013
Phone #: (405) 946-4150
Fax #: (405) 946-4150
County: OKLAHOMA
License: 587
Dated: 8/20/1975
Expires: 1/31/2014
License Type: Physical Therapist
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year: 2014
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
SELF-EMPLOYED
5622 N. PORTLAND #250
OKLAHOMA CITY OK 73112

Phone #: (405) 946-4150
Fax #: (405) 946-4150

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