Healthcare Provider Details

I. General information

NPI: 1275727109
Provider Name (Legal Business Name): MRS. JAMI CAROL MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S TELEPHONE RD SUITE 207
MOORE OK
73160-5423
US

IV. Provider business mailing address

1124 N PORTER AVE
NORMAN OK
73071-6409
US

V. Phone/Fax

Practice location:
  • Phone: 405-793-2900
  • Fax: 405-793-2901
Mailing address:
  • Phone: 405-360-6764
  • Fax: 405-360-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: