Healthcare Provider Details

I. General information

NPI: 1336348986
Provider Name (Legal Business Name): MARY ALICE WOODY C.T.R.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 E FRANK PHILLIPS BLVD POOL
BARTLESVILLE OK
74006-2411
US

IV. Provider business mailing address

3550 E FRANK PHILLIPS BLVD POOL
BARTLESVILLE OK
74006-2411
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-1512
  • Fax: 918-331-1631
Mailing address:
  • Phone: 918-331-1512
  • Fax: 918-331-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: