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General NPI Number Information
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NPI Number | 1437567773
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Entity Type | Individual
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Provider Name | MICHAEL LEE BRONSON M.ED., ATC LAT
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Gender | Male
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 180 W BROOKS ST
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City | NORMAN
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State | OK
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Zip | 73019-1018
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Country | US
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Telephone | 405-325-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 14209 BRIARCLIFF DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-7288
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Country | US
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Telephone | 405-206-3814
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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 | 503
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License Number State | OK
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