Provider Demographics
NPI:1568078673
Name:STEVENSON, CHARISSA ANN (MASSAGE THERAPISTS)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:ANN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 EPPERLY DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3322
Mailing Address - Country:US
Mailing Address - Phone:405-673-7633
Mailing Address - Fax:405-673-7638
Practice Address - Street 1:2914 EPPERLY DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3322
Practice Address - Country:US
Practice Address - Phone:405-824-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK157315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty