Healthcare Provider Details

I. General information

NPI: 1346364098
Provider Name (Legal Business Name): MANGUM PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE
MANGUM OK
73554-3034
US

IV. Provider business mailing address

400 N PENNSYLVANIA AVE
MANGUM OK
73554-3034
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-3371
  • Fax: 580-782-2313
Mailing address:
  • Phone: 580-782-3371
  • Fax: 580-782-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBERTS WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 580-782-3371