Healthcare Provider Details

I. General information

NPI: 1477323871
Provider Name (Legal Business Name): STEPHANIE RENEE BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

IV. Provider business mailing address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-6711
  • Fax: 405-438-3834
Mailing address:
  • Phone: 405-789-6711
  • Fax: 405-438-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number18
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: