Healthcare Provider Details

I. General information

NPI: 1033740121
Provider Name (Legal Business Name): TAYLOR DEEANNE PITCOCK ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W BROOKS ST NORMAN OK 1335-1
NORMAN OK
73019-0001
US

IV. Provider business mailing address

1300 STEAMBOAT WAY # 1335-1
NORMAN OK
73071-7197
US

V. Phone/Fax

Practice location:
  • Phone: 832-344-6352
  • Fax: 405-325-8388
Mailing address:
  • Phone: 832-344-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1132
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: