Healthcare Provider Details

I. General information

NPI: 1487660585
Provider Name (Legal Business Name): ANDREA FRALEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 W I 35 FRONTAGE RD SUITE 130
EDMOND OK
73013-8504
US

IV. Provider business mailing address

925 W I 35 FRONTAGE RD STE 100
EDMOND OK
73034-7399
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-3630
  • Fax: 405-757-3631
Mailing address:
  • Phone: 405-471-5460
  • Fax: 405-471-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number26519
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-115728
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number26519
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: