Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 166 | OK |
NPI | 1003021130 |
---|---|
Provider Name | Mrs. Carol Ann Belcher |
First Address | Tulsa, OK 74133-6414 |
Second Address | Broken Arrow, OK 74012-7863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |