Healthcare Provider Details

I. General information

NPI: 1700097185
Provider Name (Legal Business Name): OLIVIA ANN FEAGINS P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 S WESTERN AVE
OKLAHOMA CITY OK
73109-3410
US

IV. Provider business mailing address

805 PARKSIDE RD
NORMAN OK
73072-4235
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5200
  • Fax: 405-644-5246
Mailing address:
  • Phone: 405-447-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2479
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: