Individual
MRS. CANDACE JOANN WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3310 CHANDLER RD, MUSKOGEE, OK 74403-4906
(918) 686-0646
(918) 687-4092
Mailing address
214 W DURHAM PL, BROKEN ARROW, OK 74011-3457
(918) 455-5429
(918) 687-4092
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA532
OK
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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