Provider Demographics
NPI:1962061317
Name:OLUSTEE-ELDORADO PUBLIC SCHOOL
Entity type:Organization
Organization Name:OLUSTEE-ELDORADO PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-648-2243
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:OLUSTEE
Mailing Address - State:OK
Mailing Address - Zip Code:73560-0070
Mailing Address - Country:US
Mailing Address - Phone:580-648-2243
Mailing Address - Fax:580-648-2501
Practice Address - Street 1:606 E. 6TH STREET
Practice Address - Street 2:
Practice Address - City:OLUSTEE
Practice Address - State:OK
Practice Address - Zip Code:73560-0070
Practice Address - Country:US
Practice Address - Phone:580-648-2243
Practice Address - Fax:580-648-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty