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General NPI Number Information
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NPI Number | 1366815334
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Entity Type | Organization
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Legal Business Name | EMERALD LANE THERAPY INC.
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1016 SW C AVE STE A
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City | LAWTON
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State | OK
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Zip | 73501-4451
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Country | US
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Telephone | 580-699-8777
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Fax | 580-699-2747
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Provider Business Mailing Address
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Address Line | 1016 SW C AVE STE A
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City | LAWTON
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State | OK
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Zip | 73501-4451
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Country | US
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Telephone | 580-699-7777
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Fax | 580-699-2747
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Authorized Official
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Title or Position | CEO
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Name | AMBER LYNN DELGER
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Credential | LMT
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Telephone | 580-699-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | MT306698
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License Number State | TX
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