Provider Demographics
NPI:1023500394
Name:AITSON, TATUM TENEKE (PTA)
Entity type:Individual
Prefix:MRS
First Name:TATUM
Middle Name:TENEKE
Last Name:AITSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:TENEKE
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1312 NOEL DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7017
Mailing Address - Country:US
Mailing Address - Phone:405-425-9528
Mailing Address - Fax:405-425-9528
Practice Address - Street 1:3030 NW EXPRESSWAY STE 809
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5466
Practice Address - Country:US
Practice Address - Phone:405-655-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2017208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation