Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1689921702 |
---|---|
Provider Name | Mr. Odell V Gunter |
First Address | Lawton, OK 73505-1630 |
Second Address | Antlers, OK 74523-2045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 08/08/2012 |