Provider Demographics
NPI:1134987936
Name:NORMAN, TREVOR (MA, RD/LD, CPT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MA, RD/LD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N FLOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6909
Mailing Address - Country:US
Mailing Address - Phone:405-385-1216
Mailing Address - Fax:
Practice Address - Street 1:212 N FLOOD AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6909
Practice Address - Country:US
Practice Address - Phone:405-385-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered