Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1114355963 |
---|---|
Provider Name | Sandra Kay Twaddle |
First Address | Tuskahoma, OK 74574-1349 |
Second Address | Talihina, OK 74571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2013 |
Last Update Date | 14/10/2013 |