Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | N/A | |
N | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1730403031 |
---|---|
Provider Name | Keith A. Gladden |
First Address | Purcell, OK 73080-0662 |
Second Address | Lawton, OK 73501-7305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2010 |
Last Update Date | 16/03/2010 |