Individual
MS. IDA RAE TALLBIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 S CLARENCE NASH BLVD, WATONGA, OK 73772-4820
(580) 623-4991
Mailing address
1404 W LONDON ST, EL RENO, OK 73036-3406
(405) 274-9386
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OK
Other
Enumeration date
01/23/2026
Last updated
01/23/2026
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