Provider Demographics
NPI:1427555713
Name:SMITH, SARA NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE 122ND ST APT 4206
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8162
Mailing Address - Country:US
Mailing Address - Phone:806-884-9913
Mailing Address - Fax:
Practice Address - Street 1:100 N UNIVERSITY DRIVE
Practice Address - Street 2:ATTN: ATHLETIC TRAINING ROOM
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-974-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer