Individual
MRS. CARRA LEA BURRAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1410 SOUTH GIN ROAD, ATOKA, OK 74525
(580) 889-3399
Mailing address
809 NE 2ND ST, ANTLERS, OK 74523-2640
(580) 271-8888
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
09/18/2012
Last updated
09/18/2012
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