Individual
OCTAVIA JO WALENCIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 NW 5TH ST STE D, MOORE, OK 73160-3947
(405) 208-4469
(405) 208-4472
Mailing address
620 NW 5TH ST STE D, MOORE, OK 73160-3947
(405) 208-4469
(405) 208-4472
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Enumeration date
10/12/2022
Last updated
08/13/2025
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