Provider Demographics
NPI:1457528580
Name:FOSTER, JACEY (MT-BC)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 113
Mailing Address - Street 2:
Mailing Address - City:TURPIN
Mailing Address - State:OK
Mailing Address - Zip Code:73950-9563
Mailing Address - Country:US
Mailing Address - Phone:405-416-3394
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 113
Practice Address - Street 2:
Practice Address - City:TURPIN
Practice Address - State:OK
Practice Address - Zip Code:73950-9563
Practice Address - Country:US
Practice Address - Phone:405-416-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist