Individual
CHELSEA HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2103 S MAIN ST, ELK CITY, OK 73644-9166
(580) 225-0075
Mailing address
2103 S MAIN ST, ELK CITY, OK 73644-9166
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3122
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3122
PTA LICENSE
OK
Enumeration date
03/16/2021
Last updated
03/16/2021
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