Provider Demographics
NPI:1154894731
Name:HAYS, MITCHELL ALEXANDER
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALEXANDER
Last Name:HAYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 BRENDON DR
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-5215
Mailing Address - Country:US
Mailing Address - Phone:580-641-2658
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DRIVE
Practice Address - Street 2:ATHLETIC TRAINING DEPARTMENT
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096
Practice Address - Country:US
Practice Address - Phone:580-774-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer