Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 082152968 | OK |
NPI | 1710315882 |
---|---|
Provider Name | Toby Fisher |
First Address | Del City, OK 73115-4305 |
Second Address | Del City, OK 73115-4305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2013 |
Last Update Date | 28/10/2013 |