Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 173129 | OK |
NPI | 1003382219 |
---|---|
Provider Name | Debbie Lazar |
First Address | Oklahoma City, OK 73112-3903 |
Second Address | Oklahoma City, OK 73112-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 16/10/2018 |