Provider Demographics
NPI:1437656402
Name:OBNEY, VALERIE NICOLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:NICOLE
Last Name:OBNEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S ELM PL APT 1436
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-4876
Mailing Address - Country:US
Mailing Address - Phone:918-829-7707
Mailing Address - Fax:
Practice Address - Street 1:1709 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6502
Practice Address - Country:US
Practice Address - Phone:918-251-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant