Healthcare Provider Details

I. General information

NPI: 1295152080
Provider Name (Legal Business Name): CASEY HULTMAN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 W BRITTON RD
OKLAHOMA CITY OK
73132-1512
US

IV. Provider business mailing address

7707 W BRITTON RD
OKLAHOMA CITY OK
73132-1512
US

V. Phone/Fax

Practice location:
  • Phone: 405-720-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4043
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: