Provider Demographics
NPI:1376136630
Name:SELF, KADY (TPA)
Entity Type:Individual
Prefix:
First Name:KADY
Middle Name:
Last Name:SELF
Suffix:
Gender:F
Credentials:TPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 S BROADWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5302
Mailing Address - Country:US
Mailing Address - Phone:405-735-8777
Mailing Address - Fax:405-735-8778
Practice Address - Street 1:1700 S BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5302
Practice Address - Country:US
Practice Address - Phone:405-735-8777
Practice Address - Fax:405-735-8778
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation