Elizabeth Bley

Key facts

NPI

1124645833

Entity type

Individual (NPI type 1)

Primary specialty

Developmental Disabilities Clinic/Center 261QD1600X

Practice address

8820 Darlington Rd NW
Calumet, OK 73014-6850

Phone

(405) 401-2310

NPI assigned

Jun 29, 2020

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 23, 2020.

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1124645833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 515",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730360515",
            "telephone_number": "405-401-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8820 DARLINGTON RD NW",
            "city": "CALUMET",
            "state": "OK",
            "postal_code": "730146850",
            "telephone_number": "405-401-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEY",
        "first_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet, OK

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All providers in Calumet, OK · Developmental Disabilities Clinic/Center in Oklahoma