Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1558664094 |
---|---|
Provider Name | Ms. Elizabeth Michelle Hart |
First Address | Tishomingo, OK 73460-0794 |
Second Address | Tishomingo, OK 73460-0794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2010 |
Last Update Date | 06/12/2010 |