Provider Demographics
NPI:1316081797
Name:MARTIN, TERRI GAIL (DCSW)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:GAIL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DCSW
Other - Prefix:
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Mailing Address - Street 1:4001 KNIGHTS BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1743
Mailing Address - Country:US
Mailing Address - Phone:405-627-0276
Mailing Address - Fax:405-573-0404
Practice Address - Street 1:5725 S ROSS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-5650
Practice Address - Country:US
Practice Address - Phone:405-685-4791
Practice Address - Fax:405-573-0404
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243605802Medicare PIN