Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033493127 |
---|---|
Provider Name | Ceedee Heidor Gaddis |
First Address | Moore, OK 73160-5749 |
Second Address | Edmond, OK 73013-5046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 12/02/2022 |