Individual
TRACY LEA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 S HARRILL, ERI, WAGONER, OK 74467
(918) 485-3554
(918) 485-8371
Mailing address
109 S HARRILL, ERI, WAGONER, OK 74467
(918) 485-3554
(918) 485-8371
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/26/2007
Last updated
09/13/2007
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