FANNING, ASHLEY DIANE - Licensee Information

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

FANNING, ASHLEY DIANE

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	NORTHWEST PHYSICAL THERAPY & SPORTS REHAB 1125 40TH STREET SUITE D WOODWARD OK 73801 Address last updated on 11/19/2024
Phone #:	(580) 256-2102
Fax #:	(580) 256-1410
County:	WOODWARD
License:	4211
Dated:	7/24/2009
Expires:	1/31/2025
Temp. Ltr. Issued:	6/2/2009
Temp. Ltr. Expires:	11/20/2009
License Type:	Physical Therapist
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
NORTHWEST PHYSICAL THERAPY & SPORTS REHAB 1125 40TH STREET SUITE D WOODWARD OK 73801 Phone #: (580) 256-2102 Fax #: (580) 256-1410

Name:	Type:	License Number:
Primary Supervisees(s):
BRADY ALAN BOWLES	PT	6647
CLAYTON RAY KINCANNON	TA	3423
JADE ANESE MCCRACKEN	TA	3821
MYSHAL LEANNE OLIVE	TA	2185
AMBER DAWN TAPIA	TA	1345
KARI JO WEIAND	TA	2235

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