Provider Demographics
NPI:1326446014
Name:OKAZAKI, SHIRO ANDREW
Entity Type:Individual
Prefix:MR
First Name:SHIRO
Middle Name:ANDREW
Last Name:OKAZAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 726
Mailing Address - Street 2:
Mailing Address - City:OILTON
Mailing Address - State:OK
Mailing Address - Zip Code:74052-0726
Mailing Address - Country:US
Mailing Address - Phone:918-264-8486
Mailing Address - Fax:
Practice Address - Street 1:402 N. CAMPBELL AVE.
Practice Address - Street 2:
Practice Address - City:OILTON
Practice Address - State:OK
Practice Address - Zip Code:74052-0726
Practice Address - Country:US
Practice Address - Phone:918-264-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist