Individual
NICOLE R WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1505 RENAISSANCE BLVD, EDMOND, OK 73013-3018
(405) 850-8497
Mailing address
1505 RENAISSANCE BLVD, EDMOND, OK 73013-3018
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3740
OK
Other
Enumeration date
08/14/2024
Last updated
08/14/2024
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