Healthcare Provider Details

I. General information

NPI: 1427703495
Provider Name (Legal Business Name): ANGELA BETH SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S DOUGLAS AVE
OKLAHOMA CITY OK
73109-3210
US

IV. Provider business mailing address

2809 WINDING CREEK LN NE
PIEDMONT OK
73078-9132
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5182
  • Fax:
Mailing address:
  • Phone: 58-238-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1092
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: