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Individual

MRS. AMY LEE WACHTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CO

Contact information

Practice address
2116 E 15TH ST, TULSA, OK 74104-4614
(918) 742-6464
(918) 742-9933
Mailing address
2116 E 15TH ST, TULSA, OK 74104-4614
(918) 742-6464
(918) 742-9933

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
ALO49
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ALO49
BOARD OF MEDICAL LICENSURE & SUPERVISION STATE OF OKLAHOMA
OK
01
CO003335
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS
Enumeration date
04/03/2009
Last updated
04/03/2009
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