Provider Demographics
NPI:1932319407
Name:REICH, LILA JEAN (RPTA)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:JEAN
Last Name:REICH
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:DEWAR
Mailing Address - State:OK
Mailing Address - Zip Code:74431-0416
Mailing Address - Country:US
Mailing Address - Phone:918-652-4376
Mailing Address - Fax:918-652-4376
Practice Address - Street 1:108 SOUTH BERKEY
Practice Address - Street 2:
Practice Address - City:DEWAR
Practice Address - State:OK
Practice Address - Zip Code:74431-0416
Practice Address - Country:US
Practice Address - Phone:918-652-4376
Practice Address - Fax:918-652-4376
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA260171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor