Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1619229424 |
---|---|
Provider Name | Candice James |
First Address | Poteau, OK 74953-4224 |
Second Address | Poteau, OK 74953-4224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2012 |
Last Update Date | 04/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100746580-F | (05) | OK |