Provider Demographics
NPI:1346063153
Name:BEHRING, JACQUI (LMT)
Entity type:Individual
Prefix:
First Name:JACQUI
Middle Name:
Last Name:BEHRING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JACQUI
Other - Middle Name:
Other - Last Name:BEHRING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:204 E RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3957
Mailing Address - Country:US
Mailing Address - Phone:405-905-3953
Mailing Address - Fax:
Practice Address - Street 1:3750 W MAIN ST
Practice Address - Street 2:EXECUTIVE SUITES
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4657
Practice Address - Country:US
Practice Address - Phone:405-986-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK191743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist