Provider Demographics
NPI:1497566699
Name:ESCOTT, TATUM RAE
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:RAE
Last Name:ESCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S SHEPARD AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-6357
Mailing Address - Country:US
Mailing Address - Phone:405-766-9742
Mailing Address - Fax:
Practice Address - Street 1:1950 S SHEPARD AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6357
Practice Address - Country:US
Practice Address - Phone:405-766-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist