Individual
REBECCA LEA DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6202 S LEWIS AVE, SUITE H, TULSA, OK 74136-1099
(918) 949-4086
Mailing address
2812 PINEY CREEK RD, STIGLER, OK 74462-5157
(918) 680-1986
(918) 452-3912
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
08/11/2012
Last updated
08/11/2012
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