Basic Information
| Provider Information | |||||||||
| NPI: | 1922415082 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MCCLENDON | ||||||||
| FirstName: | HANNAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 NW EXPRESSWAY | ||||||||
| Address2: | STE 809 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059177160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3030 NW EXPRESSWAY | ||||||||
| Address2: | STE 809 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059177160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2313 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2078242 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.