Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1699059212 |
---|---|
Provider Name | Mrs. Brenda J. Thompson |
First Address | Oklahoma City, OK 73106-5629 |
Second Address | Oklahoma City, OK 73106-5629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20007978013 | (05) | OK |