Provider Demographics
NPI:1215365697
Name:OXHANDLER, GERALDINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:
Last Name:OXHANDLER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:JERIE
Other - Middle Name:K
Other - Last Name:OXHANDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:16465 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-9467
Mailing Address - Country:US
Mailing Address - Phone:269-646-3229
Mailing Address - Fax:
Practice Address - Street 1:16465 PARKER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-9467
Practice Address - Country:US
Practice Address - Phone:269-646-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist