Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1487181673 |
---|---|
Provider Name | Mr. Stephen Garrett Silva |
First Address | Tulsa, OK 74133-8029 |
Second Address | Tulsa, OK 74145-9212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2017 |
Last Update Date | 18/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03819 | ABC (01) |