Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1562 | OK |
NPI | 1003149642 |
---|---|
Provider Name | Mr. Heidi Lyn Austin |
First Address | Lawton, OK 73502-0129 |
Second Address | Lawton, OK 73505-6378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 15/09/2009 |