Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3003 | OK |
NPI | 1003492380 |
---|---|
Provider Name | Kelsey Davis |
First Address | Ardmore, OK 73401-2708 |
Second Address | Ardmore, OK 73401-2833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2021 |
Last Update Date | 18/03/2021 |