Provider Demographics
NPI:1114226602
Name:SCHULTZ, WESLEY RAY
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:RAY
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 W AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-0958
Mailing Address - Country:US
Mailing Address - Phone:405-334-6866
Mailing Address - Fax:
Practice Address - Street 1:800 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3732
Practice Address - Country:US
Practice Address - Phone:405-372-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator