Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1164706644 |
---|---|
Provider Name | Lucretia Austin |
First Address | Midwest City, OK 73110-7152 |
Second Address | Midwest City, OK 73110-7152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2011 |
Last Update Date | 03/10/2011 |