Healthcare Provider Details

I. General information

NPI: 1164677456
Provider Name (Legal Business Name): TANIKA ASHEE' HENDERSON O&P TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

8606 NE 34TH ST
SPENCER OK
73084-3276
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-1414
  • Fax:
Mailing address:
  • Phone: 405-436-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberRTP01725
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: