Provider Demographics
NPI:1790014199
Name:PURDUM, RACHEL (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PURDUM
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21825 E 460 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-3584
Mailing Address - Country:US
Mailing Address - Phone:918-825-6730
Mailing Address - Fax:
Practice Address - Street 1:1110 W WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5421
Practice Address - Country:US
Practice Address - Phone:918-342-3800
Practice Address - Fax:918-342-3900
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer