Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1508208869 |
---|---|
Provider Name | Mrs. Paula Jean Titsworth Decker |
First Address | Howe, OK 74940-7125 |
Second Address | Poteau, OK 74953-5542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 26/07/2013 |