Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1073828521 |
---|---|
Provider Name | Miss Amanda Georgeann Hagman |
First Address | Sapulpa, OK 74066-8947 |
Second Address | Sapulpa, OK 74066-8947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 09/08/2010 |