Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1306256847 |
---|---|
Provider Name | Jonelle Freeman |
First Address | Enid, OK 73701-1702 |
Second Address | Enid, OK 73701-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |