| NPI | 1669580502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE GILROY Medicaid Coordinator 918-259-4540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225100000X Physical Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-08-22 |