Individual
MIKAYLA JAMESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1900
Mailing address
26429 S 460 RD, TAHLEQUAH, OK 74464-1369
(918) 931-0175
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2354
OK
Other
Enumeration date
01/23/2023
Last updated
01/23/2023
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