Provider Demographics
NPI:1043697444
Name:MCCLURE, SUMMER (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-4022
Mailing Address - Country:US
Mailing Address - Phone:580-542-1521
Mailing Address - Fax:580-626-6472
Practice Address - Street 1:1220 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-4022
Practice Address - Country:US
Practice Address - Phone:580-542-1521
Practice Address - Fax:580-626-6472
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer