Provider Demographics
NPI:1831470566
Name:DENNIS, MICHELLE DIANE (MT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DIANE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N COO Y YAH ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-3820
Mailing Address - Country:US
Mailing Address - Phone:918-824-1601
Mailing Address - Fax:
Practice Address - Street 1:24 N COO Y YAH ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-3820
Practice Address - Country:US
Practice Address - Phone:918-824-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist