Individual
MISS ALESHA JOY LANDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 RENAISSANCE BLVD, SECOND FLOOR, EDMOND, OK 73013-3023
(405) 359-2472
Mailing address
928 ROYAL WAY, EDMOND, OK 73034-5515
(405) 249-0907
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
SOLE PROVIDER
OK
Enumeration date
05/03/2007
Last updated
07/08/2007
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