Healthcare Provider Details

I. General information

NPI: 1952669541
Provider Name (Legal Business Name): OKLAHOMA SPORTS SCIENCE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S CASS
BARTLESVILLE OK
74003
US

IV. Provider business mailing address

PO BOX 491
BARTLESVILLE OK
74005-0491
US

V. Phone/Fax

Practice location:
  • Phone: 918-889-3574
  • Fax:
Mailing address:
  • Phone: 918-889-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number74173001
License Number StateOK

VIII. Authorized Official

Name: TRACEY FLEMONS
Title or Position: PRESIDENT/CEO
Credential: TRAINER/LMT/RCEP
Phone: 918-899-3574