Healthcare Provider Details

I. General information

NPI: 1497093876
Provider Name (Legal Business Name): MICHELLE DAWN MELL BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2013
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 S WESTERN AVE SUITE 300
OKLAHOMA CITY OK
73139-1808
US

IV. Provider business mailing address

1525 GLENCLIFF DR
NORMAN OK
73071-3209
US

V. Phone/Fax

Practice location:
  • Phone: 405-602-3213
  • Fax:
Mailing address:
  • Phone: 405-426-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: