Individual
BEVERLY ANN MANTOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
117801 S 4163 RD, EUFAULA, OK 74432-6607
(918) 680-2270
Mailing address
117801 S 4163 RD, EUFAULA, OK 74432-6607
(918) 680-2270
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/04/2020
Last updated
06/04/2020
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