Healthcare Provider Details

I. General information

NPI: 1467559708
Provider Name (Legal Business Name): BONNIE JEAN REICH N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19460 8A ST.
NORMAN OK
73026-9475
US

IV. Provider business mailing address

PO BOX 381
TECUMSEH OK
74873-0381
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-2095
  • Fax: 405-366-2095
Mailing address:
  • Phone: 405-213-8533
  • Fax: 405-366-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: