Healthcare Provider Details

I. General information

NPI: 1699978007
Provider Name (Legal Business Name): MRS. RACHEL DANIELLE OBADIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
SAND SPRINGS OK
74063-7602
US

IV. Provider business mailing address

4340 S DETROIT AVE
TULSA OK
74105-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-245-5565
  • Fax: 918-245-5564
Mailing address:
  • Phone: 918-853-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: