Individual
MISS CHAREE' RENE' RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 332-3349
(580) 421-1220
Mailing address
RR 1 BOX 89J, MILL CREEK, OK 74856-9734
(580) 384-5486
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TA1190
OK
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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