Individual
JESSICA LYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9201 STATE HWY 17, ELGIN, OK 73538
(580) 713-2969
Mailing address
PO BOX 797, ELGIN, OK 73538
(580) 713-2969
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
156718
OK
Other
Enumeration date
04/06/2021
Last updated
04/06/2021
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