Individual
STACEY RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
500 S INDEPENDENCE ST, ENID, OK 73701-5632
(580) 366-7126
Mailing address
500 S INDEPENDENCE ST, ENID, OK 73701-5632
(580) 366-7126
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1369
OK
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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