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General NPI Number Information
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NPI Number | 1396412128
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Entity Type | Individual
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Provider Name | ALLISON KATE MODGLIN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1215 S BOULDER AVE
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City | TULSA
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State | OK
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Zip | 74119-2842
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Country | US
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Telephone | 918-631-2619
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Fax |
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Provider Business Mailing Address
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Address Line | 14409 S 52ND EAST AVE
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City | BIXBY
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State | OK
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Zip | 74008-4036
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Country | US
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Telephone | 918-740-2164
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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