Healthcare Provider Details

I. General information

NPI: 1144167719
Provider Name (Legal Business Name): RAEANNA STREATER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E INDEPENDENCE ST STE B
SHAWNEE OK
74804-4037
US

IV. Provider business mailing address

722 E INDEPENDENCE ST STE B
SHAWNEE OK
74804-4037
US

V. Phone/Fax

Practice location:
  • Phone: 405-765-4209
  • Fax:
Mailing address:
  • Phone: 405-765-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number300202
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: