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General NPI Number Information
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NPI Number | 1457148942
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Entity Type | Individual
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Provider Name | BRALEY RAE CLAXTON PTA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 2011 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4221
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Country | US
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Telephone | 580-622-2161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | DOUGHERTY
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State | OK
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Zip | 73032-0173
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Country | US
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Telephone | 580-490-2299
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3864
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License Number State | OK
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