Individual
TAYLOR INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 FAIRVIEW AVE, PONCA CITY, OK 74601-2053
(580) 830-0667
Mailing address
435198 E 1940 RD, FORT TOWSON, OK 74735
(580) 271-1370
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2587
OK
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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