Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1326243635 |
---|---|
Provider Name | Angela Williams-Smith |
First Address | Antlers, OK 74523-1030 |
Second Address | Idabel, OK 74745-6059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 05/06/2012 |