Individual
MOLLY MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1680 S GREATHOUSE DRIVE, ATOKA, OK 74525
(580) 297-6965
(580) 324-4181
Mailing address
1680 S GREATHOUSE DRIVE, ATOKA, OK 74525
(580) 297-6965
(580) 324-4181
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100683770A
—
OK
Enumeration date
12/01/2020
Last updated
12/01/2020
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