Individual
TINA MARIE BERGLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
7217 N COUNTY LINE ROAD, PIEDMONT, OK 73078
(174) 940-5878
Mailing address
1003 SHEPPARD ST, CHICKASHA, OK 73018-4838
(503) 753-4956
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000001848
—
Other
Enumeration date
10/14/2020
Last updated
11/01/2021
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