Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1100 | OK |
NPI | 1790980290 |
---|---|
Provider Name | Leslie E Pulliam |
First Address | Midwest City, OK 73130-6248 |
Second Address | Oklahoma City, OK 73109-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 08/07/2007 |