Provider Demographics
NPI:1548785504
Name:THOMAS, STEPHANIE MARTIN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARTIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467277 E 1060 RD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-7178
Mailing Address - Country:US
Mailing Address - Phone:918-571-2944
Mailing Address - Fax:
Practice Address - Street 1:467277 E 1060 RD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-7178
Practice Address - Country:US
Practice Address - Phone:918-571-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty