Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | J082273380 | OK |
NPI | 1184094914 |
---|---|
Provider Name | Brandon Duane Stone |
First Address | Poteau, OK 74953-7554 |
Second Address | Poteau, OK 74953-2609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 06/10/2015 |