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General NPI Number Information
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NPI Number | 1588055594
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Entity Type | Individual
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Provider Name | LINDSEY MAXWELL
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 6050 ROTHWELL ST
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City | FORT SILL
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State | OK
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Zip | 73503-4482
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Country | US
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Telephone | 405-351-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 224 S MAPLE ST
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City | CRESCENT
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State | OK
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Zip | 73028-9132
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Country | US
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Telephone |
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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 | 770
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License Number State | OK
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