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General NPI Number Information
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NPI Number | 1306704689
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Entity Type | Individual
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Provider Name | MADISON SHAYE OPITZ
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Gender | Female
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 216 E MAIN STREET
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City | HINTON
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State | OK
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Zip | 73047
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Country | US
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Telephone | 405-545-2189
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Fax |
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Provider Business Mailing Address
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Address Line | 25066 CS 2570
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City | FORT COBB
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State | OK
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Zip | 73038
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 193931
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License Number State | OK
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