Provider Demographics
NPI:1114355963
Name:TWADDLE, SANDRA KAY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:TWADDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 SW HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:TUSKAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:74574-1349
Mailing Address - Country:US
Mailing Address - Phone:918-448-3330
Mailing Address - Fax:918-567-2081
Practice Address - Street 1:410 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571
Practice Address - Country:US
Practice Address - Phone:918-567-3293
Practice Address - Fax:918-567-3294
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation