Individual
MRS. LAVERN JENNIE SULLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, MLD-C
Contact information
Practice address
8514 N 128TH EAST AVE, OWASSO, OK 74055-6242
(316) 833-3505
Mailing address
17397 E 520 RD, INOLA, OK 74036-5159
(316) 833-3505
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
157239
OK
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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