Individual
LANDRE TATUM OGLESBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
100 N UNIVERSITY DR # 190, EDMOND, OK 73034-5207
(405) 974-2188
Mailing address
13616 RED BUD RD, CHOCTAW, OK 73020-7166
(405) 250-0550
(405) 250-0550
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000029828
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73898
BOARD OF CERTIFICATION
—
Enumeration date
07/14/2017
Last updated
03/17/2018
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