Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1805 | OK |
NPI | 1033757083 |
---|---|
Provider Name | Martha Jean Griffin |
First Address | Tulsa, OK 74137-2117 |
Second Address | Tulsa, OK 74132-2117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2019 |
Last Update Date | 19/12/2019 |