Individual
MS. PATRICIA PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1111 N 36TH ST, MUSKOGEE, OK 74401-1809
(918) 683-4621
(918) 683-4002
Mailing address
HC 60 BOX 205, CHECOTAH, OK 74426-9408
(918) 473-8249
(918) 683-4002
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
425
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510163643001
BLUE CROSS/ BLUE SHIELD
OK
Enumeration date
08/30/2006
Last updated
07/09/2007
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