Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 937 | OK |
NPI | 1447342464 |
---|---|
Provider Name | Theresa Horton |
First Address | Howe, OK 74940-7341 |
Second Address | Poteau, OK 74953-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |