Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | RTP01725 | OK |
NPI | 1164677456 |
---|---|
Provider Name | Tanika Ashee' Henderson |
First Address | Spencer, OK 73084-3276 |
Second Address | Oklahoma City, OK 73104-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225000000X | ORTHO/ PROSTH FITTER (01) | OK |