Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | OK |
NPI | 1316282080 |
---|---|
Provider Name | Jeremiah Ladrone Watts |
First Address | Tulsa, OK 74146-1804 |
Second Address | Tulsa, OK 74137-4213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 06/12/2012 |