Organization
SOUTHWESTEN OKLAHOMA STATE UNIVERSITY TRAINING ROOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN DETWEILER MA, ATC, LAT, PTA (HEAD ATHLETIC TRAINER)
(580) 774-3073
Entity
Organization
Contact information
Practice address
100 CAMPUS DR, WEATHERFORD, OK 73096-3001
(972) 687-1893
Mailing address
PO BOX 819020, DALLAS, TX 75381-9020
(972) 687-1893
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/17/2011
Last updated
08/17/2011
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