Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1124378377 |
---|---|
Provider Name | Kolby Stobbe |
First Address | Lawton, OK 73507-7112 |
Second Address | Lawton, OK 73507-7112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2012 |
Last Update Date | 14/09/2012 |