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General NPI Number Information
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NPI Number | 1417493313
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Entity Type | Organization
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Legal Business Name | KINDRED WINGS
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 2816 PACIFICA LN
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City | EDMOND
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State | OK
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Zip | 73034-6099
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Country | US
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Telephone | 405-740-2247
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Fax |
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Provider Business Mailing Address
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Address Line | 2816 PACIFICA LN
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City | EDMOND
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State | OK
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Zip | 73034-6099
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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 | FOUNDER & PRESIDENT
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Name | KRISTEN RADER
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Credential |
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Telephone | 405-740-2247
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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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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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