Individual
ELLEN EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 12TH AVE NE, NORMAN, OK 73071-5237
(405) 321-4880
Mailing address
216 MIMOSA DR, NORMAN, OK 73069-8652
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
15
OK
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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