Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1820 | OK |
NPI | 1003394636 |
---|---|
Provider Name | Mrs. Karen Rae Smith |
First Address | Tulsa, OK 74136-7039 |
Second Address | Tulsa, OK 74136-7039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |