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ADRIAN LAMAR PROPHET

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
115 W 15TH ST STE B, EDMOND, OK 73013-3642
(405) 535-6339
Mailing address
417 MADISON CT, MOORE, OK 73160-6744

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
182962
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
182962
MASSAGE THERAPIST
OK
Enumeration date
03/14/2020
Last updated
03/14/2020
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