Provider Demographics
NPI:1841317955
Name:WELLS, DOROTHY E (PT)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:E
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-1254
Mailing Address - Country:US
Mailing Address - Phone:918-231-5194
Mailing Address - Fax:191-836-7987
Practice Address - Street 1:37241 W. 181 ST. S
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-1254
Practice Address - Country:US
Practice Address - Phone:918-231-5194
Practice Address - Fax:918-367-9875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist