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General NPI Number Information
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NPI Number | 1528977675
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Entity Type | Individual
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Provider Name | TIA D WOMACK
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Gender | Female
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 1600 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-2128
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Country | US
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Telephone | 580-706-6936
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Fax | 855-708-5544
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Provider Business Mailing Address
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Address Line | 313 ALLEN LN
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City | CALERA
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State | OK
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Zip | 74730-2513
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Country | US
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Telephone | 580-706-6936
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Fax | 855-708-5544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 26-2834850
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License Number State | OK
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