Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1275806002 |
---|---|
Provider Name | Flecelia Renee Leverett |
First Address | Bethany, OK 73008-3447 |
Second Address | Bethany, OK 73008-3447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2012 |
Last Update Date | 09/02/2012 |