Healthcare Provider Details

I. General information

NPI: 1548670367
Provider Name (Legal Business Name): MICHAEL HEPPLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 S ADAMS ST
STILLWATER OK
74074-5441
US

IV. Provider business mailing address

1119 S ADAMS ST
STILLWATER OK
74074-5441
US

V. Phone/Fax

Practice location:
  • Phone: 405-612-5799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: