Provider Demographics
NPI:1710634746
Name:MARQUEZ, MEAGAN DAYNE (PTA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:DAYNE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:DAYNE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:514 CRIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-7004
Mailing Address - Country:US
Mailing Address - Phone:580-309-3621
Mailing Address - Fax:
Practice Address - Street 1:5608 SE 67TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1719
Practice Address - Country:US
Practice Address - Phone:405-254-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant