Individual
NIKI SANDRA LATENDRESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
20585 S 4200 RD, CLAREMORE, OK 74019-4289
(918) 343-1868
Mailing address
20585 S 4200 RD, CLAREMORE, OK 74019-4289
(918) 343-1868
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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