Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | RPOA6 | OK |
NPI | 1639316383 |
---|---|
Provider Name | Kory Sams |
First Address | Tulsa, OK 74104-4614 |
Second Address | Tulsa, OK 74104-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2009 |
Last Update Date | 17/01/2009 |