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Individual

DONNA SUE EDGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
1107 W BROADWAY ST, ARDMORE, OK 73401-2833
(580) 226-5566
(580) 226-5567
Mailing address
1405 4TH AVE NW # 296, ARDMORE, OK 73401-2708
(580) 795-4561
(580) 223-6448

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
707
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200110030A
OK
Enumeration date
04/06/2007
Last updated
01/24/2020
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