Provider Demographics
NPI:1215277835
Name:WHATLEY, MIKELLA A
Entity type:Individual
Prefix:
First Name:MIKELLA
Middle Name:A
Last Name:WHATLEY
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:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:HENNEPIN
Mailing Address - State:OK
Mailing Address - Zip Code:73444-0233
Mailing Address - Country:US
Mailing Address - Phone:580-247-0225
Mailing Address - Fax:
Practice Address - Street 1:1301 KIOWA ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2280
Practice Address - Country:US
Practice Address - Phone:580-226-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor