Basic Information
| Provider Information | |||||||||
| NPI: | 1811347438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1071 W BLUE STARR DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740172868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183423800 | ||||||||
| FaxNumber: | 9183423900 | ||||||||
| Practice Location | |||||||||
| Address1: | 434 S CHEROKEE ST | ||||||||
| Address2: | |||||||||
| City: | CATOOSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740152710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182666200 | ||||||||
| FaxNumber: | 9182666206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5174 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.