Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1457674475 |
---|---|
Provider Name | Kimberly R Anderson |
First Address | Antlers, OK 74523-1030 |
Second Address | Hugo, OK 74743-4250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2010 |
Last Update Date | 05/06/2012 |