Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1659636744 |
---|---|
Provider Name | Lacey Jay Doty |
First Address | Sulphur, OK 73086-0268 |
Second Address | Antlers, OK 74523-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 05/07/2012 |