1881645604 NPI number — STACY ELIZABETH MCGLORY OTR/L, CHT

Table of content: STACY ELIZABETH MCGLORY OTR/L, CHT (NPI 1881645604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881645604 NPI number — STACY ELIZABETH MCGLORY OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGLORY
Provider First Name:
STACY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
STACY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/ L , CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881645604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 NW 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73106-7241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-609-3667
Provider Business Mailing Address Fax Number:
800-506-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4645 W GORE BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505-6041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-355-6785
Provider Business Practice Location Address Fax Number:
580-355-6788
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  1031100248 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT405 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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