Provider Demographics
NPI:1194247866
Name:PARKER, TE'ONNA KAY (MMP, LMT)
Entity type:Individual
Prefix:MRS
First Name:TE'ONNA
Middle Name:KAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17071 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-7700
Mailing Address - Country:US
Mailing Address - Phone:405-403-8923
Mailing Address - Fax:
Practice Address - Street 1:501 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6849
Practice Address - Country:US
Practice Address - Phone:405-403-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK173268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist