Organization
WHOLISTIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TABETHA NICOLE MATHIESEN M.S. CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(405) 795-7110
Entity
Organization
Contact information
Practice address
1409 S DIVISION ST, GUTHRIE, OK 73044-5009
(405) 795-7110
Mailing address
205 E CIMARRON BLVD, CRESCENT, OK 73028-9296
(405) 795-7110
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3775
OK
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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