Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1245580380 |
---|---|
Provider Name | Ms. Shante L Fenner |
First Address | Oklahoma City, OK 73120-7242 |
Second Address | Oklahoma City, OK 73120-7242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 17/09/2012 |