Healthcare Provider Details

I. General information

NPI: 1023886827
Provider Name (Legal Business Name): BONNIELYN ELIZABETH FITE BARTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S EUCALYPTUS AVE
BROKEN ARROW OK
74012
US

IV. Provider business mailing address

6209 S 116TH EAST AVE
BROKEN ARROW OK
74012-1250
US

V. Phone/Fax

Practice location:
  • Phone: 918-324-6201
  • Fax:
Mailing address:
  • Phone: 918-324-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number182124
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: