MEDICARE: EMILY C GREGORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		OK

General Provider Information

NPI Number	:	1891515250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY C GREGORY

Provider Business Mailing Address
First Line	:	7207 E JACKSON PL
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-2834
Country	:	US
Telephone Number	:	918-734-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 S EUCALYPTUS AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6159
Country	:	US
Telephone Number	:	918-324-6201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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Directions to “ EMILY C GREGORY ” Practice Location

Language	Start Address	Practice Location

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