Individual
ASHLEY NICOLE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6192
(580) 379-5820
(580) 379-5829
Mailing address
1200 E PECAN ST, ALTUS, OK 73521-6192
(580) 379-5820
(580) 379-5829
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2106
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200880560A
—
OK
Enumeration date
04/24/2019
Last updated
04/01/2025
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