1073939260 NPI number — MRS. KELLI ANN TRAVIS

Table of content: HILLARY BELL ATC, LAT (NPI 1669975199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073939260 NPI number — MRS. KELLI ANN TRAVIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVIS
Provider First Name:
KELLI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLEN
Provider Other First Name:
KELLI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073939260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 S MAIN ST (BROKEN ARROW PUBLIC SCHOOLS-SPECIAL SERV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-259-5700
Provider Business Mailing Address Fax Number:
918-455-2588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S MAIN ST (BROKEN ARROW PUBLIC SCHOOLS-SPECIAL SERV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN ARROW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-259-5700
Provider Business Practice Location Address Fax Number:
918-455-2588
Provider Enumeration Date:
03/12/2014

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: 235Z00000X , with the licence number:  1592 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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