# EAGLE SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942624135
- **Authorized official:** MS. MICHELLE LEA KRAUSE PT/ATC (REHABILITATION COORDINATOR)
- **Authorized official phone:** (580) 272-4978

## Contact information

- **Practice address:** 2501 E MEMORIAL RD, EDMOND, OK 73013-5525
- **Practice address phone:** (405) 425-1960
- **Practice address fax:** (405) 425-1962
- **Mailing address:** 2501 E MEMORIAL RD, EDMOND, OK 73013-5525
- **Mailing address phone:** (405) 425-1960
- **Mailing address fax:** (405) 425-1962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | 2813 | OK | Yes |

## Other

- **Enumeration date:** 02/10/2014
- **Last updated:** 10/26/2016