Provider Demographics
NPI:1457713752
Name:DRISKILL, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DRISKILL
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 1:5617 SE 67TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1725
Mailing Address - Country:US
Mailing Address - Phone:405-455-7860
Mailing Address - Fax:405-455-7865
Practice Address - Street 1:5617 SE 67TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1725
Practice Address - Country:US
Practice Address - Phone:405-455-7860
Practice Address - Fax:405-455-7865
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2592225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant