Provider Demographics
NPI:1013550359
Name:FORD, TERRI L
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:L
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 RODGERS DR
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-2877
Mailing Address - Country:US
Mailing Address - Phone:405-379-6668
Mailing Address - Fax:
Practice Address - Street 1:117 RODGERS DR
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2877
Practice Address - Country:US
Practice Address - Phone:405-379-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator