Individual
TIFFANY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 N BROADWAY ST STE 1, POTEAU, OK 74953-2617
(918) 649-0772
Mailing address
19441 RHINO RD, BOKOSHE, OK 74930-2275
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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