Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | P082823145 | OK |
NPI | 1114344223 |
---|---|
Provider Name | Jordan Harvey |
First Address | Healdton, OK 73438-1417 |
Second Address | Healdton, OK 73438-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |