| NPI | 1063681104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA MERI CHAPPELL Athletics Insurance Coordinator 405-744-5430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OK 17462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3509) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 465) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |