Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2149 | OK |
NPI | 1023527884 |
---|---|
Provider Name | Kylah Clovis |
First Address | Tulsa, OK 74135-7438 |
Second Address | Tulsa, OK 74135-7438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 25/09/2017 |