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General NPI Number Information
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NPI Number | 1245756857
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Entity Type | Individual
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Provider Name | RANDA CASTLEBERRY
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Gender | Female
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 100 N UNIVERSITY DR # 190
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City | EDMOND
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State | OK
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Zip | 73034-5207
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Country | US
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Telephone | 405-974-3876
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 S RIPLEY RD
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City | STILLWATER
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State | OK
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Zip | 74074-7078
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Country | US
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Telephone | 405-714-3091
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 942
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License Number State | OK
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