Provider Demographics
NPI:1972827517
Name:PAULK, CASEY REECE (AT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:REECE
Last Name:PAULK
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 S YALE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7815
Mailing Address - Country:US
Mailing Address - Phone:918-494-9300
Mailing Address - Fax:918-494-9324
Practice Address - Street 1:6475 S YALE AVE STE 301
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7815
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9324
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer