Provider Demographics
NPI:1508083379
Name:SCALES, JENNA SUE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:SUE
Last Name:SCALES
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:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:EAKLY
Mailing Address - State:OK
Mailing Address - Zip Code:73033-0232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 WEST ADAMS
Practice Address - Street 2:
Practice Address - City:CORN
Practice Address - State:OK
Practice Address - Zip Code:73024
Practice Address - Country:US
Practice Address - Phone:580-343-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant