Individual
MEGAN S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
604 S WALNUT ST, STILLWATER, OK 74074-4222
(405) 372-2202
(405) 445-3780
Mailing address
604 S WALNUT ST, STILLWATER, OK 74074-4222
(405) 372-2202
(405) 445-3780
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE
—
Enumeration date
07/15/2019
Last updated
07/29/2019
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