Provider Demographics
NPI:1548132947
Name:BIRDSALL, SKYLAR N
Entity type:Individual
Prefix:MS
First Name:SKYLAR
Middle Name:N
Last Name:BIRDSALL
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 1:114 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2244
Mailing Address - Country:US
Mailing Address - Phone:918-630-1233
Mailing Address - Fax:
Practice Address - Street 1:4733 KIBLER RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-8406
Practice Address - Country:US
Practice Address - Phone:479-268-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant