Individual
JUSTIN LYNN CICOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
(918) 256-9890
Mailing address
404 E. EXCELSIOR AVE., VINITA, OK 74301
(918) 265-6476
(918) 256-9890
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/20/2019
Last updated
11/24/2021
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