Healthcare Provider Details

I. General information

NPI: 1306750666
Provider Name (Legal Business Name): ADDISON BROWN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CLARK BASS BLVD
MCALESTER OK
74501-4209
US

IV. Provider business mailing address

52305 440TH AVE
TALIHINA OK
74571-2319
US

V. Phone/Fax

Practice location:
  • Phone: 318-426-1800
  • Fax:
Mailing address:
  • Phone: 918-471-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4211
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: