| NPI | 1912104670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OK 200020230A) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: OK 200020230B) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2007-07-13 |