Provider Demographics
NPI:1891372769
Name:DOTSON, MALEYA
Entity Type:Individual
Prefix:
First Name:MALEYA
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41247 HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-9116
Mailing Address - Country:US
Mailing Address - Phone:580-670-3117
Mailing Address - Fax:
Practice Address - Street 1:34 N WASHINGTON
Practice Address - Street 2:1301 KIOWA
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7340
Practice Address - Country:US
Practice Address - Phone:580-670-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician