Healthcare Provider Details

I. General information

NPI: 1215923057
Provider Name (Legal Business Name): JILL MARIE SEELKE R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W OWEN K GARRIOTT RD
ENID OK
73701-5619
US

IV. Provider business mailing address

PO BOX 6064
ENID OK
73702-6064
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-7896
  • Fax: 580-233-6699
Mailing address:
  • Phone: 580-237-7896
  • Fax: 580-233-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1695
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: