Provider Demographics
NPI:1780931543
Name:CHELENZA, CONNIE M (CPO, LPO)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:M
Last Name:CHELENZA
Suffix:
Gender:F
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W GORE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3661
Mailing Address - Country:US
Mailing Address - Phone:580-699-8690
Mailing Address - Fax:580-966-8692
Practice Address - Street 1:1915 W GORE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3661
Practice Address - Country:US
Practice Address - Phone:580-699-8690
Practice Address - Fax:580-966-8692
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO92224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist