Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1154685766 |
---|---|
Provider Name | Joshua Robertson |
First Address | Coyle, OK 73027 |
Second Address | Coyle, OK 73027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |