Healthcare Provider Details

I. General information

NPI: 1215875281
Provider Name (Legal Business Name): BRAYLEE MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 S CENTRAL AVE
IDABEL OK
74745-4625
US

IV. Provider business mailing address

510 N HIGH ST
ANTLERS OK
74523-2247
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-9726
  • Fax: 580-271-6790
Mailing address:
  • Phone: 580-209-6112
  • Fax: 580-271-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: