Healthcare Provider Details

I. General information

NPI: 1740389626
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - ALLIED HEALTH CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1215
US

IV. Provider business mailing address

1200 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1215
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2866
  • Fax: 405-271-3360
Mailing address:
  • Phone: 405-271-2866
  • Fax: 405-271-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JENIELLE GREENLEE
Title or Position: DIRECTOR
Credential: PT,MPH,FAPTA
Phone: 405-271-2131