Provider Demographics
NPI:1104652742
Name:FAVORS, VALENCIA RAQCHEL
Entity type:Individual
Prefix:
First Name:VALENCIA
Middle Name:RAQCHEL
Last Name:FAVORS
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 1:900 NE 122ND ST APT 2905
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8187
Mailing Address - Country:US
Mailing Address - Phone:405-248-0190
Mailing Address - Fax:
Practice Address - Street 1:900 NE 122ND ST APT 2905
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8187
Practice Address - Country:US
Practice Address - Phone:405-248-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist