Provider Demographics
NPI:1750668885
Name:WHITEFIELD, AUSTIN CLAY (PTA)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:CLAY
Last Name:WHITEFIELD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4611
Mailing Address - Country:US
Mailing Address - Phone:580-436-3633
Mailing Address - Fax:
Practice Address - Street 1:511 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4611
Practice Address - Country:US
Practice Address - Phone:580-436-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist