Healthcare Provider Details

I. General information

NPI: 1437656402
Provider Name (Legal Business Name): VALERIE NICOLE OBNEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 S MAIN ST
BROKEN ARROW OK
74012-6502
US

IV. Provider business mailing address

4801 S ELM PL APT 1436
BROKEN ARROW OK
74011-4876
US

V. Phone/Fax

Practice location:
  • Phone: 918-251-2626
  • Fax:
Mailing address:
  • Phone: 918-829-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2763
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: