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General NPI Number Information
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NPI Number | 1174989768
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Entity Type | Individual
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Provider Name | MICHELLE DUNHAM
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 1215 S WESTERN RD
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City | STILLWATER
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State | OK
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Zip | 74074-5151
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Country | US
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Telephone | 843-530-5682
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Fax |
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Provider Business Mailing Address
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Address Line | 920 S MURPHY ST APT 8101
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City | STILLWATER
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State | OK
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Zip | 74074-1755
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Country | US
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Telephone | 843-530-5682
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2472
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License Number State | OK
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