Provider Demographics
NPI:1336348986
Name:WOODY, MARY ALICE (CTRS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:WOODY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3550 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:POOL
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2411
Mailing Address - Country:US
Mailing Address - Phone:918-331-1512
Mailing Address - Fax:918-331-1631
Practice Address - Street 1:3550 E FRANK PHILLIPS BLVD
Practice Address - Street 2:POOL
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-331-1512
Practice Address - Fax:918-331-1631
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist