Individual
IDA PASCHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
613 NW 121ST ST, OKLAHOMA CITY, OK 73114-8308
(405) 406-0613
Mailing address
613 NW 121ST ST, OKLAHOMA CITY, OK 73114-8308
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/26/2017
Last updated
03/29/2018
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