Healthcare Provider Details

I. General information

NPI: 1467364984
Provider Name (Legal Business Name): SAMANTHA MAYNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 FAIRLAWN DR
NORMAN OK
73071-3622
US

IV. Provider business mailing address

1600 BAYCHARTER ST
NORMAN OK
73071-7254
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-5879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF942
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: