Healthcare Provider Details

I. General information

NPI: 1063347052
Provider Name (Legal Business Name): BRANDY BETH BRASKET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NW 63RD ST STE 132
OKLAHOMA CITY OK
73116-1934
US

IV. Provider business mailing address

6500 N GRAND BLVD APT 168
OKLAHOMA CITY OK
73116-3429
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-9423
  • Fax:
Mailing address:
  • Phone: 405-468-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number209253
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: