Provider Demographics
NPI:1194697136
Name:SWAILS, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SWAILS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7058
Mailing Address - Country:US
Mailing Address - Phone:405-731-1992
Mailing Address - Fax:
Practice Address - Street 1:1121 S DOUGLAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5210
Practice Address - Country:US
Practice Address - Phone:405-731-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician