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Provider Information for 1417391954

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1417391954

Calendar   Last Updated:  2021-06-15
  Certification Date:  2021-06-15


Name Value
NPI 1417391954
Enumeration Date 2013-04-27
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2 MILLER DR
CHICKASHA, OK 73018-6127
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 304 S 29TH ST
CHICKASHA, OK 73018-2501
United States

Phone: 405-224-3100 | Fax: 405-224-3102
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 225100000X - Physical Therapist OK 4429