Individual
CARLTON CLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5022 W HILTON RD, SAPULPA, OK 74066-1123
(918) 695-4835
Mailing address
5022 W HILTON RD, SAPULPA, OK 74066-1123
(918) 695-4835
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200514400A
—
OK
Enumeration date
01/26/2018
Last updated
01/26/2018
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