Provider Demographics
NPI:1992161509
Name:THOMAS, KARLYSE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KARLYSE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 WEST EAGLE BLVD
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:GOODWELL
Mailing Address - State:OK
Mailing Address - Zip Code:73939
Mailing Address - Country:US
Mailing Address - Phone:580-349-1338
Mailing Address - Fax:580-349-1419
Practice Address - Street 1:323 WEST EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:GOODWELL
Practice Address - State:OK
Practice Address - Zip Code:73939
Practice Address - Country:US
Practice Address - Phone:580-349-1338
Practice Address - Fax:580-349-1419
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer