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General NPI Number Information
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NPI Number | 1598051047
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Entity Type | Individual
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Provider Name | LAURIE LEE MCCUNE BHRS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 2109 S HIGHWAY 69
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City | WAGONER
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State | OK
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Zip | 74467-9310
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Country | US
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Telephone | 918-485-0242
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Fax | 918-485-0204
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Provider Business Mailing Address
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Address Line | 812 W ATLANTA PL
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City | BROKEN ARROW
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State | OK
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Zip | 74012-6911
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Country | US
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Telephone | 918-232-9014
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Fax | 918-615-6529
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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