Healthcare Provider Details

I. General information

NPI: 1700795804
Provider Name (Legal Business Name): RAYMOND ERNEST MAYFIELD OTR/L,CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL
BROKEN ARROW OK
74012-7877
US

IV. Provider business mailing address

24206 E 116TH ST S
BROKEN ARROW OK
74014-7771
US

V. Phone/Fax

Practice location:
  • Phone: 918-451-5143
  • Fax: 918-451-5287
Mailing address:
  • Phone: 918-451-5143
  • Fax: 918-451-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number533
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: