Healthcare Provider Details

I. General information

NPI: 1093827271
Provider Name (Legal Business Name): ROBIN LYNN PLOEGER ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TUCKER DR CHAPMAN HALL 355
TULSA OK
74104-9700
US

IV. Provider business mailing address

800 TUCKER DR
TULSA OK
74104-9700
US

V. Phone/Fax

Practice location:
  • Phone: 918-631-3170
  • Fax: 918-631-2068
Mailing address:
  • Phone: 918-631-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 146
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: