Healthcare Provider Details

I. General information

NPI: 1982923298
Provider Name (Legal Business Name): JOANNA CORLETT MOATS BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W OXFORD AVE
ENID OK
73701-1208
US

IV. Provider business mailing address

605 W OXFORD AVE
ENID OK
73701-1208
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-7220
  • Fax: 580-237-7550
Mailing address:
  • Phone: 580-233-7220
  • Fax: 580-237-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: