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General NPI Number Information
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NPI Number | 1073902003
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Entity Type | Individual
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Provider Name | BRITINI LEEP MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 248 E GEORGIA TER
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City | MUSTANG
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State | OK
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Zip | 73064-6559
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Country | US
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Telephone | 405-229-0472
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Fax |
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Provider Business Mailing Address
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Address Line | 248 E GEORGIA TER
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City | MUSTANG
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State | OK
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Zip | 73064-6559
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 24-00974
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License Number State | KS
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