Provider Demographics
NPI:1942456702
Name:DIERKSEN, SABRINA COLLEEN (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:COLLEEN
Last Name:DIERKSEN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MISS
Other - First Name:SABRINA
Other - Middle Name:COLLEEN
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S RALEIGH RD
Mailing Address - Street 2:OCCUPATIONAL HEALTH DEPT.
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7800
Mailing Address - Country:US
Mailing Address - Phone:580-616-4793
Mailing Address - Fax:580-616-1071
Practice Address - Street 1:201 S RALEIGH RD
Practice Address - Street 2:OCCUPATIONAL HEALTH DEPT.
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7800
Practice Address - Country:US
Practice Address - Phone:580-616-4793
Practice Address - Fax:580-616-1071
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK522OtherSTATE LICENSE NUMBER
OK04115786643OtherAHA BLS INSTUCTOR
090402325OtherNATIONAL CERTIFICATION