Individual
MR. MICAH JEROD LITTLEJOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
715 N BREWER ST, VINITA, OK 74301-1426
(918) 256-9207
Mailing address
616 MEADOWLARK LN, COMMERCE, OK 74339-3147
(918) 533-4292
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1741
OK
Other
Enumeration date
07/08/2009
Last updated
07/08/2009
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