Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OK | |
Y | 226300000X | Kinesiotherapist | OK |
NPI | 1568007417 |
---|---|
Provider Name | Corrine Robertson |
First Address | Tulsa, OK 74128-6226 |
Second Address | Tulsa, OK 74128-6226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |