Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1326485129 |
---|---|
Provider Name | Debra Antley |
First Address | Lawton, OK 73505 |
Second Address | Lawton, OK 73505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 03/06/2013 |