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
State | License ID | Taxonomies |
---|---|---|
OK | 74173001 | 173C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 173C00000X | Other Service Providers | Reflexologist | Group - Multi-Specialty |