Individual
AMELIA WADDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12008 CANTLE RD, OKLAHOMA CITY, OK 73120-8028
(405) 537-4752
Mailing address
12008 CANTLE RD, OKLAHOMA CITY, OK 73120-8028
(405) 537-4752
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2660
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2660
PTA
OK
Enumeration date
02/14/2017
Last updated
02/14/2017
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