Provider Demographics
NPI:1366752883
Name:WHEATLEY-GRIMES, PATSY RUTH (MA SECONDARY ED)
Entity type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:RUTH
Last Name:WHEATLEY-GRIMES
Suffix:
Gender:F
Credentials:MA SECONDARY ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-4434
Practice Address - Country:US
Practice Address - Phone:405-683-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst