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General NPI Number Information
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NPI Number | 1558763482
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Entity Type | Individual
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Provider Name | MYRIA OAKLEY LAT-ATC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 9300 E 29TH ST N
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City | WICHITA
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State | KS
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Zip | 67226-2182
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Country | US
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Telephone | 316-219-8299
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Fax | 316-219-5899
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Provider Business Mailing Address
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Address Line | 12 LANSDOWNE DR
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City | WICHITA
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State | KS
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Zip | 67220-4907
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Country | US
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Telephone | 316-650-5279
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2400702
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License Number State | KS
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