Individual
KATY LEIGH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
113 W SHAWNEE ST, TAHLEQUAH, OK 74464-3623
(918) 825-1405
(918) 825-1406
Mailing address
113 W SHAWNEE ST, TAHLEQUAH, OK 74464-3623
(918) 825-1405
(918) 825-1406
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
08/01/2016
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