Healthcare Provider Details

I. General information

NPI: 1013442193
Provider Name (Legal Business Name): SEASON GRAVES ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEASON PIERCE ATC, LAT

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W GORE BLVD
LAWTON OK
73505-6320
US

IV. Provider business mailing address

301 8TH ST
SNYDER OK
73566-2005
US

V. Phone/Fax

Practice location:
  • Phone: 580-581-2408
  • Fax: 580-581-5537
Mailing address:
  • Phone: 620-204-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number651
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: