Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1689962037 |
---|---|
Provider Name | Rosa Thomas |
First Address | Midwest City, OK 73130-6033 |
Second Address | Midwest City, OK 73130-6033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 19/07/2011 |