Healthcare Provider Details

I. General information

NPI: 1306175385
Provider Name (Legal Business Name): CHANDRA M. DYER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ACADEMY RD
GUTHRIE OK
73044-8727
US

IV. Provider business mailing address

200 S ACADEMY RD P.O. BOX 1017
GUTHRIE OK
73044-8727
US

V. Phone/Fax

Practice location:
  • Phone: 405-683-1550
  • Fax:
Mailing address:
  • Phone: 405-380-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number569
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: