Provider Demographics
NPI:1063968287
Name:MRA CONTRACTING SERVICES LLC
Entity type:Organization
Organization Name:MRA CONTRACTING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNEE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ALTEBAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:405-777-9160
Mailing Address - Street 1:656 KINGSTON DR.
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3823
Mailing Address - Country:US
Mailing Address - Phone:405-777-9160
Mailing Address - Fax:405-592-6313
Practice Address - Street 1:656 KINGSTON PL
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3823
Practice Address - Country:US
Practice Address - Phone:405-777-9160
Practice Address - Fax:405-592-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1821266701Medicaid