Provider Demographics
NPI:1063873271
Name:COLES, JASON LYN (MS,LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LYN
Last Name:COLES
Suffix:
Gender:M
Credentials:MS,LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 NW 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4407
Mailing Address - Country:US
Mailing Address - Phone:620-518-1649
Mailing Address - Fax:
Practice Address - Street 1:6729 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2605
Practice Address - Country:US
Practice Address - Phone:405-789-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer