Provider Demographics
NPI:1215368261
Name:PAPPAN, LACEY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:PAPPAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 3008
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-3008
Mailing Address - Country:US
Mailing Address - Phone:918-333-5100
Mailing Address - Fax:918-333-5102
Practice Address - Street 1:1355 W ROGERS BLVD
Practice Address - Street 2:10
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-4204
Practice Address - Country:US
Practice Address - Phone:918-333-5100
Practice Address - Fax:918-333-5102
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522010Medicaid
OK1215368261Medicare UPIN
OK200522010Medicaid