Healthcare Provider Details

I. General information

NPI: 1861500969
Provider Name (Legal Business Name): DONITA R TEFFT M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

042 MURRAY
STILLWATER OK
74078-5062
US

IV. Provider business mailing address

129 E MARIE DR
STILLWATER OK
74075-1676
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-6021
  • Fax: 405-744-8070
Mailing address:
  • Phone: 580-402-2568
  • Fax: 405-744-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3107
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: