Individual
TIESHIA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4308 MEADOWOAK DR, MIDWEST CITY, OK 73110-7017
(405) 882-6665
Mailing address
4308 MEADOWOAK DR, MIDWEST CITY, OK 73110-7017
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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