Individual
WESLEY GRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
603 NORTH GRAND AVENUE, TAHLEQUAH, OK 74464
(918) 444-3970
Mailing address
603 NORTH GRAND AVENUE, TAHLEQUAH, OK 74464
(918) 444-3970
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
559
OK
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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