Healthcare Provider Details

I. General information

NPI: 1316644388
Provider Name (Legal Business Name): ZALEE MAE DENSMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE
TULSA OK
74114-3300
US

IV. Provider business mailing address

2325 S HARVARD AVE
TULSA OK
74114-3300
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-9471
  • Fax:
Mailing address:
  • Phone: 918-587-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-281766
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: