Provider Demographics
NPI:1366815334
Name:EMERALD LANE THERAPY INC.
Entity type:Organization
Organization Name:EMERALD LANE THERAPY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DELGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:580-699-8777
Mailing Address - Street 1:1016 SW C AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4451
Mailing Address - Country:US
Mailing Address - Phone:580-699-7777
Mailing Address - Fax:580-699-2747
Practice Address - Street 1:1016 SW C AVE STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4451
Practice Address - Country:US
Practice Address - Phone:580-699-8777
Practice Address - Fax:580-699-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT3066982083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty