Provider Demographics
NPI:1003140237
Name:DARITY, MICHELE CAROL (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:CAROL
Last Name:DARITY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 S SHAW RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-5174
Mailing Address - Country:US
Mailing Address - Phone:580-509-9125
Mailing Address - Fax:580-326-8850
Practice Address - Street 1:1001 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743
Practice Address - Country:US
Practice Address - Phone:580-509-9125
Practice Address - Fax:580-326-8850
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist