Provider Demographics
NPI:1730474073
Name:SENSIBAUGH, IVORA PALESTINE
Entity Type:Individual
Prefix:
First Name:IVORA
Middle Name:PALESTINE
Last Name:SENSIBAUGH
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 1:100 SOUTH MAIN
Mailing Address - Street 2:SUITE NUMBER B
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5370
Mailing Address - Country:US
Mailing Address - Phone:918-423-3700
Mailing Address - Fax:918-423-3712
Practice Address - Street 1:100 SOUTH MAIN
Practice Address - Street 2:SUITE NUMBER B
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5370
Practice Address - Country:US
Practice Address - Phone:918-423-3700
Practice Address - Fax:918-423-3712
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker