Healthcare Provider Details

I. General information

NPI: 1588580955
Provider Name (Legal Business Name): MA CASSANDRA COLONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N UNIVERSITY DR
EDMOND OK
73034-5207
US

IV. Provider business mailing address

605 CATALINA PL
ELGIN OK
73538-3858
US

V. Phone/Fax

Practice location:
  • Phone: 405-974-2000
  • Fax:
Mailing address:
  • Phone: 580-574-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: