Individual
SAMANTHA JO MIRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
628 E CREEK AVE, MCALESTER, OK 74501-6930
(918) 421-3500
Mailing address
PO BOX 1404, MCALESTER, OK 74502-1404
(918) 421-3500
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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