Provider Demographics
NPI:1225524440
Name:MEDLEY, MELISSA LEIGH (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-494-9341
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:6585 S YALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8315
Practice Address - Country:US
Practice Address - Phone:918-481-2767
Practice Address - Fax:918-486-7611
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK8862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer