Individual
REBECCA RUEANNE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
608 HIGHWAY 271 N, ANTLERS, OK 74523-2055
(580) 298-5062
Mailing address
677 ROSS RD, BROKEN BOW, OK 74728-5558
(580) 306-5557
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
08/28/2012
Last updated
03/18/2014
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