Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1720371586 |
---|---|
Provider Name | Carol J Brown |
First Address | Madill, OK 73446-2248 |
Second Address | Madill, OK 73446-2248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 25/05/2011 |