Provider Demographics
NPI:1457387425
Name:HERRILL, MATTHEW REED (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:REED
Last Name:HERRILL
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATHLETICS CENTER
Mailing Address - Street 2:ATHLETIC TRAINING ROOM
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078
Mailing Address - Country:US
Mailing Address - Phone:405-744-1340
Mailing Address - Fax:405-744-0358
Practice Address - Street 1:ATHLETICS CENTER
Practice Address - Street 2:ATHLETIC TRAINING ROOM
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-0001
Practice Address - Country:US
Practice Address - Phone:405-744-1340
Practice Address - Fax:405-744-0358
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer