Healthcare Provider Details

I. General information

NPI: 1821293887
Provider Name (Legal Business Name): DORTHY JEAN MAXEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27907 S BIG HOLLOW RD
PARK HILL OK
74451
US

IV. Provider business mailing address

27907 S BIG HOLLOW RD
PARK HILL OK
74451
US

V. Phone/Fax

Practice location:
  • Phone: 918-457-4801
  • Fax: 918-457-4801
Mailing address:
  • Phone: 918-457-4801
  • Fax: 918-457-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: