=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891196622
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA-ANN L. MAYOTTE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 MCGEE DR SUITE 113
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73072-5774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-202-4112
-----------------------------------------------------
Fax | 405-360-8888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 MCGEE DR SUITE 113
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73072-5774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-202-4112
-----------------------------------------------------
Fax | 405-360-8888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1432
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------