MEDICARE: CHRISTINA CADDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1053791178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA CADDY

Provider Business Mailing Address
First Line	:	20 NW MISSION BLVD
Second Line	:	L12
City	:	LAWTON
State	:	OK
Zip	:	73507-2226
Country	:	US
Telephone Number	:	253-228-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 NW MISSION BLVD
Second Line	:	L12
City	:	LAWTON
State	:	OK
Zip	:	73507-2226
Country	:	US
Telephone Number	:	253-228-4035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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Directions to “ CHRISTINA CADDY ” Practice Location

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