Healthcare Provider Details

I. General information

NPI: 1891006243
Provider Name (Legal Business Name): PORSCHE A REIMER-LAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 PENNINGTON AVE
EDMOND OK
73012-6560
US

IV. Provider business mailing address

2601 PENNINGTON AVE
EDMOND OK
73012-6560
US

V. Phone/Fax

Practice location:
  • Phone: 580-761-3027
  • Fax:
Mailing address:
  • Phone: 580-761-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: