Provider Demographics
NPI:1851843304
Name:WRIGHT, WALTER LEONARD II (MED, LAT, ATC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:LEONARD
Last Name:WRIGHT
Suffix:II
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15417 S COUNTY ROAD 211
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:OK
Mailing Address - Zip Code:73526-9322
Mailing Address - Country:US
Mailing Address - Phone:580-819-2505
Mailing Address - Fax:
Practice Address - Street 1:15417 S CR 211
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:OK
Practice Address - Zip Code:73526
Practice Address - Country:US
Practice Address - Phone:580-819-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer