Provider Demographics
NPI:1295906899
Name:TEEL, JEANNE (RPT, CLT)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:TEEL
Suffix:
Gender:F
Credentials:RPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4610
Mailing Address - Country:US
Mailing Address - Phone:580-332-3349
Mailing Address - Fax:580-421-1220
Practice Address - Street 1:3101 ARLINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3085
Practice Address - Country:US
Practice Address - Phone:580-332-3349
Practice Address - Fax:580-421-1220
Is Sole Proprietor?:No
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist