Individual
BROOK COLBURN DETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CMLDT
Contact information
Practice address
1501 N FLORENCE AVE, CLAREMORE, OK 74017-3179
(918) 706-1302
Mailing address
417 SCRAPER ST, CATOOSA, OK 74015-2509
(918) 706-1302
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
157786
OK
Other
Enumeration date
09/16/2022
Last updated
09/16/2022
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