Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1659782183 |
---|---|
Provider Name | Janna Smith |
First Address | Oklahoma City, OK 73105-5108 |
Second Address | Oklahoma City, OK 73105-5108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103TR0400X | BEHAVIOR REHABILITATION (01) | OK |