Healthcare Provider Details

I. General information

NPI: 1417493313
Provider Name (Legal Business Name): KINDRED WINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 PACIFICA LN
EDMOND OK
73034-6099
US

IV. Provider business mailing address

2816 PACIFICA LN
EDMOND OK
73034-6099
US

V. Phone/Fax

Practice location:
  • Phone: 405-740-2247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTEN RADER
Title or Position: FOUNDER & PRESIDENT
Credential:
Phone: 405-740-2247