Provider Demographics
NPI:1033740121
Name:PITCOCK, TAYLOR DEEANNE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:DEEANNE
Last Name:PITCOCK
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STEAMBOAT WAY # 1335-1
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-7197
Mailing Address - Country:US
Mailing Address - Phone:832-344-6352
Mailing Address - Fax:
Practice Address - Street 1:180 W BROOKS ST NORMAN OK 1335-1
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-0001
Practice Address - Country:US
Practice Address - Phone:832-344-6352
Practice Address - Fax:405-325-8388
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1132OtherLAT