Individual
LISA CARRASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5555 E 71ST ST, SUITE 7120, TULSA, OK 74136-6542
(918) 367-6960
Mailing address
18491 N JAMESTOWN, SKIATOOK, OK 74070-4290
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
865
OK
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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