Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2017 | OK |
NPI | 1023500394 |
---|---|
Provider Name | Mrs. Tatum Teneke Aitson |
First Address | Yukon, OK 73099-7017 |
Second Address | Oklahoma City, OK 73112-5466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2018 |
Last Update Date | 03/06/2018 |