Provider Demographics
NPI:1912117664
Name:VEATCH, TRAVIS JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JAMES
Last Name:VEATCH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 HEFNER VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7757
Mailing Address - Country:US
Mailing Address - Phone:405-717-6256
Mailing Address - Fax:405-717-6287
Practice Address - Street 1:6729 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2605
Practice Address - Country:US
Practice Address - Phone:405-717-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer