Individual
MELISA LAYNE STOUT-HERRING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT ATC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1394
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100834080A
—
OK
01
—
611494900
DEPT OF LABOR
OK
01
—
P00253426
RR MEDICARE
OK
Enumeration date
12/23/2005
Last updated
05/18/2020
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