Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1225373194 |
---|---|
Provider Name | Jenice Jones |
First Address | Antlers, OK 74523-2250 |
Second Address | Antlers, OK 74523-2250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 04/12/2012 |