Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2036 | OK |
NPI | 1013490689 |
---|---|
Provider Name | Jade Bell |
First Address | Yukon, OK 73099-6803 |
Second Address | Yukon, OK 73099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2018 |
Last Update Date | 10/09/2018 |