Individual
AMANDA LEIGH FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4017 E GRANDSTAFF, CUSHING, OK 74023-8708
(904) 803-7719
Mailing address
4017 E GRANDSTAFF, CUSHING, OK 74023-8708
(904) 803-7719
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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