Individual
JACOB ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9201 STATE HIGHWAY 17 STE F, ELGIN, OK 73538-4517
(580) 454-9200
(580) 454-9205
Mailing address
PO BOX 817, ELGIN, OK 73538-0817
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1047
OK
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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