Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | OK |
NPI | 1285064295 |
---|---|
Provider Name | Miss Stacey Ashalintubbi |
First Address | Tuskahoma, OK 74574-9729 |
Second Address | Tuskahoma, OK 74574-9729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 13/11/2013 |