Provider Demographics
NPI:1427133909
Name:ALLEN, MARILYN L (PT, CHT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5635
Mailing Address - Country:US
Mailing Address - Phone:918-748-7500
Mailing Address - Fax:918-748-7615
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7500
Practice Address - Fax:918-748-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10902251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand