Provider Demographics
NPI:1245573583
Name:WIGLEY-ELLIOTT, APRIL LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:APRIL
Middle Name:LYNN
Last Name:WIGLEY-ELLIOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-8965
Mailing Address - Country:US
Mailing Address - Phone:580-235-8047
Mailing Address - Fax:
Practice Address - Street 1:119 N BROADWAY AVE STE 10
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-235-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK172582225700000X
TXMT103888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK172582OtherOK STATE BOARD OF COSMETOLOGY
TXMT103888OtherSTATE OF TEXAS