Healthcare Provider Details

I. General information

NPI: 1992460679
Provider Name (Legal Business Name): KAYLEY SLONE CHILDS LAT, PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEY SLONE CUNNINGHAM

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ROTHWELL ST
LAWTON OK
73503-4478
US

IV. Provider business mailing address

5955 ROTHWELL ST
LAWTON OK
73503-4478
US

V. Phone/Fax

Practice location:
  • Phone: 580-442-1955
  • Fax:
Mailing address:
  • Phone: 580-442-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5564
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1396
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: