Individual
ETTA K THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 NW 39TH, STE 103, OKLAHOMA CITY, OK 73112
(405) 412-2021
(405) 606-7893
Mailing address
2401 NW 39TH, STE 103, OKLAHOMA CITY, OK 73112
(405) 412-2021
(405) 606-7893
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
302598
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200519830A
—
OK
Enumeration date
08/13/2010
Last updated
07/09/2014
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