Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003439100 |
---|---|
Provider Name | Mrs. Carolyn Y Thomas |
First Address | Broken Arrow, OK 74012-7436 |
Second Address | Broken Arrow, OK 74012-7436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 22/05/2020 |