Individual
MICAH JO STALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N UNIVERSITY DR # 190, EDMOND, OK 73034-5207
(405) 974-3876
Mailing address
1609 GREENLEAF LN, EDMOND, OK 73013
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OK
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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