Provider Demographics
NPI:1588891683
Name:SCAMMAHORN, ERIN RAE (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:RAE
Last Name:SCAMMAHORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-3528
Mailing Address - Country:US
Mailing Address - Phone:405-375-7945
Mailing Address - Fax:405-375-7987
Practice Address - Street 1:500 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-3528
Practice Address - Country:US
Practice Address - Phone:405-375-7945
Practice Address - Fax:405-375-7987
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 2949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist