Provider Demographics
NPI:1306669270
Name:BIANCHINI, MIKALYN DALANIE (PTA)
Entity type:Individual
Prefix:
First Name:MIKALYN
Middle Name:DALANIE
Last Name:BIANCHINI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MIKALYN
Other - Middle Name:DALANIE
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1827
Practice Address - Country:US
Practice Address - Phone:580-251-8460
Practice Address - Fax:580-251-8979
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant