Healthcare Provider Details

I. General information

NPI: 1639586811
Provider Name (Legal Business Name): SCOTT MCCAULLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 SE 74TH ST STE 500
OKLAHOMA CITY OK
73135-1088
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-6320
  • Fax: 405-610-6325
Mailing address:
  • Phone: 405-809-8710
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4834
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: