Individual
JESSICA VANDYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
7777 S LEWIS AVE, TULSA, OK 74171-0001
(605) 212-8627
Mailing address
7777 S LEWIS AVE, TULSA, OK 74136-7741
(605) 212-8627
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1000
OK
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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