Provider Demographics
NPI:1477260461
Name:MCKEEVER, TRACY DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DAWN
Last Name:MCKEEVER
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 1:1705 CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1405
Mailing Address - Country:US
Mailing Address - Phone:580-475-7515
Mailing Address - Fax:
Practice Address - Street 1:HWY 70 & HWY 81
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573
Practice Address - Country:US
Practice Address - Phone:580-228-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK576OtherPTA LICENSE