Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | OK |
NPI | 1003362583 |
---|---|
Provider Name | Tammy Serena Adams |
First Address | Talihina, OK 74571-6023 |
Second Address | Talihina, OK 74571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2016 |
Last Update Date | 25/08/2016 |