Individual
MRS. MALLERY GRAY GANNAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
12301 N MACARTHUR BLVD APT 304, OKLAHOMA CITY, OK 73142-3039
(405) 406-7112
Mailing address
12301 N MACARTHUR BLVD APT 304, OKLAHOMA CITY, OK 73142-3039
(405) 406-7112
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OK
390200000X
Student in an Organized Health Care Education/Training Program
737
OK
Other
Enumeration date
01/08/2018
Last updated
01/08/2018
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