=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821199217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGUERITA LYNN CAGLE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 10/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10901 E 76TH ST N
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-212-1051
-----------------------------------------------------
Fax | 918-212-1052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17813 E 92ND ST N
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-8046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-342-2622
-----------------------------------------------------
Fax | 918-342-2641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 973
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------