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General NPI Number Information
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NPI Number | 1053968909
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Entity Type | Individual
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Provider Name | NATHANIEL BRANT RADCLIFF OTR
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Gender | Male
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 2225 N MAIN ST
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City | MIAMI
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State | OK
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Zip | 74354-1620
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Country | US
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Telephone | 918-542-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 16102 PAWNEE DR
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City | TYLER
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State | TX
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Zip | 75703-7965
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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