Individual
MELISSA DELAINE EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29140 E 156TH ST S, COWETA, OK 74429-4122
(918) 402-2556
Mailing address
29140 E 156TH ST S, COWETA, OK 74429-4122
(918) 402-2556
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/30/2016
Last updated
11/30/2016
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