Healthcare Provider Details

I. General information

NPI: 1538159553
Provider Name (Legal Business Name): SANDRA KAY OVER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 150TH STREET SUITE A2
EDMOND OK
73013-3429
US

IV. Provider business mailing address

100 NW 150TH STREET SUITE A2
EDMOND OK
73013-3429
US

V. Phone/Fax

Practice location:
  • Phone: 405-513-6465
  • Fax: 405-471-6477
Mailing address:
  • Phone: 405-513-6465
  • Fax: 405-471-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number102
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: