Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | OK |
NPI | 1427610526 |
---|---|
Provider Name | Ms. Alita Javon Littlejohn |
First Address | Edmond, OK 73013-2946 |
Second Address | Edmond, OK 73013-2946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |