Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1164851614 |
---|---|
Provider Name | Sidney Deupree |
First Address | Antlers, OK 74523-1055 |
Second Address | Antlers, OK 74523-2237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 05/11/2013 |