Provider Demographics
NPI:1295144384
Name:WILSON, STEPHANIE LEE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34637 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-8583
Mailing Address - Country:US
Mailing Address - Phone:405-238-7000
Mailing Address - Fax:405-238-7005
Practice Address - Street 1:440 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6470
Practice Address - Country:US
Practice Address - Phone:405-809-8710
Practice Address - Fax:405-573-6768
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist