=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710209242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CURTIS WILLIAMS ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2010
-----------------------------------------------------
Last Update Date | 02/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 SILVER LAKE ROAD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-335-6200
-----------------------------------------------------
Fax | 918-335-6246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 SE HAMPDEN RD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-7313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-397-3603
-----------------------------------------------------
Fax | 918-335-6246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT237
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------