Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2529 | OK |
N | 2251P0200X | Physical Therapist - Pediatrics | 2529 | OK |
NPI | 1053405639 |
---|---|
Provider Name | Mrs. Angela Elaine Holder |
First Address | Gould, OK 73544 |
Second Address | Lawton, OK 73507-3432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 22/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200038480A | (05) | OK |
200038480B | (05) | OK |