Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1033550520 |
---|---|
Provider Name | Jayme Elizabeth Burnett-Green |
First Address | Wynnewood, OK 73098-4626 |
Second Address | Wynnewood, OK 73098-4626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 23/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200507080A | (05) | OK |