Healthcare Provider Details

I. General information

NPI: 1588070486
Provider Name (Legal Business Name): MICHAEL BARLOW ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 I ST NE
MIAMI OK
74354-6434
US

IV. Provider business mailing address

200 I ST NE
MIAMI OK
74354-6434
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-6323
  • Fax:
Mailing address:
  • Phone: 918-540-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT116
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: