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Individual

MECHELLE RENEE DODGION

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
6715 E 41ST ST, TULSA, OK 74145-4520
(918) 806-0106
(918) 806-0113
Mailing address
12464 S 417TH WEST AVE, BRISTOW, OK 74010-8756
(918) 638-7211

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TA250
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
TA250
OK
Enumeration date
01/14/2021
Last updated
01/14/2021
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