Individual
MRS. PAMELA K ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15481 N JARVIS RD, TAHLEQUAH, OK 74464-0233
(918) 456-5131
Mailing address
275 REDBUD LN, TAHLEQUAH, OK 74464-4902
(918) 822-4488
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OK
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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