Individual
ALISHA BAUCHMOYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1218 S RUSSELL ST, SKIATOOK, OK 74070-2128
(918) 327-0294
Mailing address
1218 S RUSSELL ST, SKIATOOK, OK 74070-2128
(918) 327-0294
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
01/24/2016
Last updated
01/24/2016
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