Provider Demographics
NPI:1972325967
Name:OGLES, DIANSE
Entity type:Individual
Prefix:
First Name:DIANSE
Middle Name:
Last Name:OGLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAHNI
Other - Middle Name:
Other - Last Name:OGLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:729 EAST WILSHIRE BOULEVARD
Mailing Address - Street 2:129
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105
Mailing Address - Country:US
Mailing Address - Phone:405-898-4197
Mailing Address - Fax:
Practice Address - Street 1:729 EAST WILSHIRE BOULEVARD
Practice Address - Street 2:129
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-898-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist