Provider Demographics
NPI:1194592758
Name:TABLER, TRUDY
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:TABLER
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 1:5668 LAMAR CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2036
Mailing Address - Country:US
Mailing Address - Phone:405-613-8434
Mailing Address - Fax:
Practice Address - Street 1:1233 W LINDSEY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4307
Practice Address - Country:US
Practice Address - Phone:405-443-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator