Individual
MR. ZACHARY DANIEL COLLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC, LAT
Contact information
Practice address
600 N GRAND AVE, TAHLEQUAH, OK 74464-2301
(918) 456-5511
(918) 458-2339
Mailing address
903 SHERYL ST, TAHLEQUAH, OK 74464-8021
(417) 848-1741
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
454
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
454
STATE LICENSURE NUMBER
OK
Enumeration date
11/15/2006
Last updated
07/08/2007
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