Provider Demographics
NPI:1366190589
Name:MASSAY, ALICIA MICHELLE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
Last Name:MASSAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W WRANGLER BLVD APT 129
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-2000
Mailing Address - Country:US
Mailing Address - Phone:405-543-7871
Mailing Address - Fax:
Practice Address - Street 1:2215 W WRANGLER BLVD APT 129
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2000
Practice Address - Country:US
Practice Address - Phone:405-543-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist