Provider Demographics
NPI:1205366051
Name:PAYNE, DANA M (ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 W UNIVERSITY BLVD APT 10107
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3052
Mailing Address - Country:US
Mailing Address - Phone:580-775-3049
Mailing Address - Fax:
Practice Address - Street 1:1405 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3330
Practice Address - Country:US
Practice Address - Phone:580-745-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer