Provider Demographics
NPI:1043331804
Name:DODSON, DANIEL L (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:DODSON
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13905 KIRKLAND RDG
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7080
Mailing Address - Country:US
Mailing Address - Phone:405-255-7208
Mailing Address - Fax:
Practice Address - Street 1:13905 KIRKLAND RDG
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7080
Practice Address - Country:US
Practice Address - Phone:405-255-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer