Healthcare Provider Details

I. General information

NPI: 1871656702
Provider Name (Legal Business Name): DYSPHAGIA SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 STONE DR
BLANCHARD OK
73010-1227
US

IV. Provider business mailing address

1238 STONE DR
BLANCHARD OK
73010-1227
US

V. Phone/Fax

Practice location:
  • Phone: 405-721-2879
  • Fax: 405-773-4848
Mailing address:
  • Phone: 405-721-2879
  • Fax: 405-773-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: SHELLY STRATTON
Title or Position: PRESIDENT
Credential:
Phone: 405-721-2879