Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 944 | OK |
NPI | 1003825050 |
---|---|
Provider Name | Mrs. Jessica Sang |
First Address | Owasso, OK 74055-4021 |
Second Address | Owasso, OK 74055-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 12/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100645670A | (05) | OK |