Individual
MRS. SAMANTHA RENEE NOSSAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC, LPMT
Contact information
Practice address
7170 S BRADEN AVE STE 195, TULSA, OK 74136-6324
(918) 280-0900
Mailing address
7170 S BRADEN AVE STE 195, TULSA, OK 74136-6324
(918) 280-0090
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1848760
OK
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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