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Individual

MR. DONALD WALLER JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CMT

Contact information

Practice address
715 S 2ND ST, MCALESTER, OK 74501-5815
(918) 426-5897
Mailing address
715 S 2ND ST, MCALESTER, OK 74501-5815
(918) 426-5897

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
555144
OK

Other

Enumeration date
10/30/2012
Last updated
10/30/2012
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