Individual
MISS IAYISHA RENEA HIGGINBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 N CLASSEN BLVD, SUITE 214, OKLAHOMA CITY, OK 73106-6835
(405) 601-6710
(405) 601-6711
Mailing address
1331 N CLASSEN BLVD, OKLAHOMA CITY, OK 73106
(405) 601-6710
(405) 601-6711
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/21/2011
Last updated
12/31/2013
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