Individual
MR. CHAD LEWIS DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOTR/L
Contact information
Practice address
2417 E 53RD ST, TULSA, OK 74105-6601
(918) 712-8412
Mailing address
2417 E 53RD ST, TULSA, OK 74105-6601
(918) 712-8412
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1642
OK
Other
Enumeration date
03/11/2010
Last updated
03/11/2010
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