Individual
TAMMY GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
304 W 2ND ST, WELLSTON, OK 74881-9496
(405) 635-5097
Mailing address
335414 E 880 RD, WELLSTON, OK 74881-8247
(405) 635-5097
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
144501
OK
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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