Healthcare Provider Details

I. General information

NPI: 1134217847
Provider Name (Legal Business Name): MARCE' HOTZ MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 FAWN RUN DR
YUKON OK
73099-2356
US

IV. Provider business mailing address

4924 FAWN RUN DR
YUKON OK
73099-2356
US

V. Phone/Fax

Practice location:
  • Phone: 405-823-8289
  • Fax:
Mailing address:
  • Phone: 405-823-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2980
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: