Provider Demographics
NPI:1083140750
Name:TROXELL, EMILIE TAYLOR (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:EMILIE
Middle Name:TAYLOR
Last Name:TROXELL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MRS
Other - First Name:EMILIE
Other - Middle Name:TAYLOR
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:15409 CARDINAL NEST DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1068
Mailing Address - Country:US
Mailing Address - Phone:806-898-4100
Mailing Address - Fax:
Practice Address - Street 1:15409 CARDINAL NEST DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1068
Practice Address - Country:US
Practice Address - Phone:806-898-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer