Individual
THOMAS JOHN HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1630 S KERR BLVD, SALLISAW, OK 74955-7240
(918) 790-2653
Mailing address
701 KODY LN, SALLISAW, OK 74955-2021
(918) 571-6777
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/19/2021
Last updated
01/19/2021
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