MEDICARE: MR. DAVID W. STANLEY ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	84	OK

General Provider Information

NPI Number	:	1770857476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID W. STANLEY ATC

Provider Business Mailing Address
First Line	:	7 NW WENTWOOD HILL DR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-9500
Country	:	US
Telephone Number	:	580-678-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 NW FORT SILL BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73507-6601
Country	:	US
Telephone Number	:	580-355-5170
Fax Number	:	580-585-6433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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