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General NPI Number Information
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NPI Number | 1508692559
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Entity Type | Individual
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Provider Name | HEATHER RAE BRETZ
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1178 W CHEROKEE ST
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City | JAY
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State | OK
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Zip | 74346-3406
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Country | US
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Telephone | 918-253-5731
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W CHEROKEE ST
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City | JAY
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State | OK
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Zip | 74346-3300
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Country | US
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Telephone | 501-556-7242
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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