Provider Demographics
NPI:1275727109
Name:MCDONALD, JAMI CAROL
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:CAROL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6409
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:405-360-6769
Practice Address - Street 1:520 S TELEPHONE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5423
Practice Address - Country:US
Practice Address - Phone:405-793-2900
Practice Address - Fax:405-793-2901
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist