Provider Demographics
NPI:1770347023
Name:CLAXTON, STACY LYNN (CMM)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:CLAXTON
Suffix:
Gender:F
Credentials:CMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 COLBERT ST
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-1019
Mailing Address - Country:US
Mailing Address - Phone:405-203-3103
Mailing Address - Fax:
Practice Address - Street 1:1106 E STATE HIGHWAY 152 UNIT 1
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-5134
Practice Address - Country:US
Practice Address - Phone:405-256-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1795225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist