Individual
TANIKA ASHEE' HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O&P TECH
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1414
Mailing address
8606 NE 34TH ST, SPENCER, OK 73084-3276
(405) 436-5106
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
RTP01725
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225000000X
ORTHO/ PROSTH FITTER
OK
Enumeration date
12/01/2008
Last updated
12/01/2008
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