Provider Demographics
NPI:1245961408
Name:RADTKE, BRANDI JANAE
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:JANAE
Last Name:RADTKE
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 1:2209 E SOONER RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-6634
Mailing Address - Country:US
Mailing Address - Phone:405-387-4880
Mailing Address - Fax:
Practice Address - Street 1:2209 E SOONER RD
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-6634
Practice Address - Country:US
Practice Address - Phone:405-387-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist