Provider Demographics
NPI:1366840753
Name:BACKER, PATTY
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:
Last Name:BACKER
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 1:4 E CLARK BASS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4285
Mailing Address - Country:US
Mailing Address - Phone:918-421-8897
Mailing Address - Fax:918-302-0825
Practice Address - Street 1:4 E CLARK BASS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4285
Practice Address - Country:US
Practice Address - Phone:918-421-8897
Practice Address - Fax:918-302-0825
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic