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General NPI Number Information
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NPI Number | 1295144384
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Entity Type | Individual
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Provider Name | STEPHANIE LEE WILSON DPT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 440 MERCHANT DR
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City | NORMAN
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State | OK
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Zip | 73069-6470
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Country | US
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Telephone | 405-809-8710
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Fax | 405-573-6768
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Provider Business Mailing Address
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Address Line | 34637 AIRLINE RD
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City | PAULS VALLEY
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State | OK
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Zip | 73075-8583
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Country | US
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Telephone | 405-238-7000
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Fax | 405-238-7005
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4810
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License Number State | OK
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