Provider Demographics
NPI:1952669541
Name:OKLAHOMA SPORTS SCIENCE INSTITUTE INC
Entity Type:Organization
Organization Name:OKLAHOMA SPORTS SCIENCE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:TRAINER/LMT/RCEP
Authorized Official - Phone:918-899-3574
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74005-0491
Mailing Address - Country:US
Mailing Address - Phone:918-889-3574
Mailing Address - Fax:
Practice Address - Street 1:314 S CASS
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-889-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74173001173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty