Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114204948 |
---|---|
Provider Name | Terence Lange |
First Address | Norman, OK 73071-2355 |
Second Address | Norman, OK 73071-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2011 |
Last Update Date | 08/11/2011 |