Provider Demographics
NPI:1861883894
Name:DANIELS, PATTY (BA IN ED; ME)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:BA IN ED; ME
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:LYNN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA IN ED; ME
Mailing Address - Street 1:1300 HOPPE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2318
Mailing Address - Country:US
Mailing Address - Phone:580-436-2603
Mailing Address - Fax:580-272-5734
Practice Address - Street 1:1300 HOPPE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2318
Practice Address - Country:US
Practice Address - Phone:580-436-2603
Practice Address - Fax:580-272-5734
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator