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MANCILLAS-LOVELESS, MARY DOLORES       
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: 3026 4TH AVE SOUTH
GREAT FALLS MT 59405

Address last updated on 12/23/1999
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 321
Dated: 6/30/1994
Expires: 1/31/1998
Temp. Ltr. Issued: 4/14/1994
Temp. Ltr. Expires: 7/23/1994
License Type: Physical Therapist Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year:
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:
3026 4TH AVE SOUTH
GREAT FALLS MT 59405

Phone #:
Fax #:

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