Individual
COULTER LOUIS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED, ATC, LAT
Contact information
Practice address
355 S OSAGE ST, SKIATOOK, OK 74070-2015
(918) 396-5710
Mailing address
106 N BROADWAY ST STE C, SKIATOOK, OK 74070-1222
(580) 548-3283
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
673
OK
Other
Enumeration date
04/30/2015
Last updated
03/21/2016
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