Basic Information
| Provider Information | |||||||||
| NPI: | 1518165034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNN | ||||||||
| FirstName: | MARLEKA | ||||||||
| MiddleName: | KAI | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3313 OVERLAND DR | ||||||||
| Address2: | |||||||||
| City: | DEL CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731151821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058632168 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3030 NW EXPRESSWAY ST | ||||||||
| Address2: | SUITE 809 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059177160 | ||||||||
| FaxNumber: | 4059177161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PTA1401 | OK | Y | Other Service Providers | Specialist |
No ID Information.