Healthcare Provider Details

I. General information

NPI: 1619142643
Provider Name (Legal Business Name): JAIME ANNETTE MCNEILL L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S CARSON AVE SUITE 3100
TULSA OK
74119
US

IV. Provider business mailing address

UNIVERSITY CLUB TOWERS 1722 S CARSON AVE SUITE 3100
TULSA OK
74119
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-7111
  • Fax: 918-587-1177
Mailing address:
  • Phone: 918-587-7111
  • Fax: 918-587-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM5025
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: