Provider Demographics
NPI:1912027780
Name:FLANAGAN, REBECCA DIANE (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2150
Mailing Address - Country:US
Mailing Address - Phone:405-605-9795
Mailing Address - Fax:
Practice Address - Street 1:815 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6802
Practice Address - Country:US
Practice Address - Phone:405-230-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAT2222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer