Provider Demographics
NPI:1508229675
Name:BAGGETT, JULIE (ATC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BAGGETT
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 1:100 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6439
Mailing Address - Country:US
Mailing Address - Phone:580-548-2369
Mailing Address - Fax:580-628-6296
Practice Address - Street 1:100 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6439
Practice Address - Country:US
Practice Address - Phone:580-548-2369
Practice Address - Fax:580-628-6296
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAT3802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer