Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1700211075 |
---|---|
Provider Name | Thelma Beatrica Boaz |
First Address | Tulsa, OK 74136-3717 |
Second Address | Tulsa, OK 74106-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 05/09/2013 |