Individual
SUSAN MICHELLE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1202 N MUSKOGEE PL, CLAREMORE, OK 74017-3058
(918) 342-6703
(918) 342-7889
Mailing address
PO BOX 2394, CLAREMORE, OK 74018-2394
(918) 636-1234
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1270
OK
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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