Provider Demographics
NPI:1265303408
Name:ROTHERMEL, RYAN EDWARD
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:EDWARD
Last Name:ROTHERMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-0088
Mailing Address - Country:US
Mailing Address - Phone:580-740-6642
Mailing Address - Fax:
Practice Address - Street 1:2403 REDWOOD LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2053
Practice Address - Country:US
Practice Address - Phone:580-740-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker