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1821583402
JACOB THOMAS HISELEY
PRYOR, OK
NPI
1821583402
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
Enumeration Date
2018-06-26
Last Update Date
2018-06-26
Business Address
JACOB THOMAS HISELEY
109 N FAIRLAND ST
PRYOR, OK 74361-4203
Phone number: 918-273-1841
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Mailing Address
JACOB THOMAS HISELEY
109 N FAIRLAND ST
PRYOR, OK 74361-4203
Phone number: 918-273-1841
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