Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1205249349 |
---|---|
Provider Name | Qiana Hawthorne |
First Address | Guthrie, OK 73044-7750 |
Second Address | Guthrie, OK 73044-7750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 06/06/2014 |