Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1093063836 |
---|---|
Provider Name | Miss Elizabeth Ayala |
First Address | Lawton, OK 73501-7305 |
Second Address | Lawton, OK 73501-7305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2012 |
Last Update Date | 15/01/2013 |