Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1194070037 |
---|---|
Provider Name | Laura Durbin |
First Address | Atoka, OK 74525-3016 |
Second Address | Atoka, OK 74525-3016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 21/09/2012 |