Individual
MRS. SHELLEY KAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
(580) 371-2369
Mailing address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
W081093352
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226970A
—
OK
Enumeration date
12/19/2012
Last updated
12/19/2012
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