Individual
JACQUELYN DOVE PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4300 W HOUSTON ST, BROKEN ARROW, OK 74012-4519
(918) 307-0233
(918) 307-0233
Mailing address
4049 E 23RD ST, TULSA, OK 74114-3431
(918) 510-1270
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
417
OK
Other
Enumeration date
12/20/2012
Last updated
12/20/2012
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