1861667396 NPI number — MARILYN L ALLEN

Table of content: (NPI 1861667396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861667396 NPI number — MARILYN L ALLEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILYN L ALLEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAND REHABILITATION OF TULSA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861667396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 S WHEELING AVE
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-5638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-748-4500
Provider Business Mailing Address Fax Number:
918-748-7615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S WHEELING AVE
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-748-4500
Provider Business Practice Location Address Fax Number:
918-748-7615
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
DEENA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
918-748-7500

Provider Taxonomy Codes

  • Taxonomy code: 2251H1200X , with the licence number:  1090 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 1090 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100836340A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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