Basic Information
Provider Information | |||||||||
NPI: | 1407248735 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAVIS | ||||||||
FirstName: | BRIDGET | ||||||||
MiddleName: | THERESA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AU.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAFFIN | ||||||||
OtherFirstName: | BRIDGET | ||||||||
OtherMiddleName: | THERESA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | AU.D | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2000 S WHEELING AVE STE 900 | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741045647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9184036284 | ||||||||
FaxNumber: | 9184036323 | ||||||||
Practice Location | |||||||||
Address1: | 2000 S WHEELING AVE STE 900 | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741045647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9184036284 | ||||||||
FaxNumber: | 9184036323 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/24/2015 | ||||||||
LastUpdateDate: | 03/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | SP-1057-AU | MA | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | 5257 | OK | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.