Provider Demographics
NPI:1841627544
Name:CASE, STEVI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:STEVI
Middle Name:LYNN
Last Name:CASE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 D ST NW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3232
Mailing Address - Country:US
Mailing Address - Phone:918-314-6628
Mailing Address - Fax:
Practice Address - Street 1:923 D ST NW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-3232
Practice Address - Country:US
Practice Address - Phone:918-314-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2307225200000X
KS14-02608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2307OtherPTA LICENSURE
KS14-02608OtherPTA LICENSURE