Individual
THOMAS WAYNE GAUTHIER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1452 W ROCKPORT ST, BROKEN ARROW, OK 74012-0432
(918) 924-0774
Mailing address
1452 W ROCKPORT ST, BROKEN ARROW, OK 74012-0432
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
09/23/2025
Last updated
09/23/2025
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