Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | OK |
NPI | 1316227275 |
---|---|
Provider Name | Felton Chile Madume |
First Address | Ada, OK 74820-9491 |
Second Address | Ada, OK 74820-9491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2011 |
Last Update Date | 24/08/2011 |