Provider Demographics
NPI:1861832800
Name:ATCHLEY, HEATHER DAWN (MS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DAWN
Last Name:ATCHLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-2807
Mailing Address - Country:US
Mailing Address - Phone:918-868-7103
Mailing Address - Fax:
Practice Address - Street 1:821 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2807
Practice Address - Country:US
Practice Address - Phone:918-253-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist