Individual
TINA E TAKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6525 N MERIDIAN AVE, SUITE 311, OKLAHOMA CITY, OK 73116-1420
(405) 721-1115
Mailing address
134 NE 21ST ST, MOORE, OK 73160-4410
(405) 923-0069
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
TA218
OK
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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