MRS. Lavern Jennie Sullins, LMT, MLD-C

NPI #1558185918 in Owasso, Oklahoma

Provider Information

NPI Number: 1558185918
Entity Type: Individual
Name: MRS. Lavern Jennie Sullins, LMT, MLD-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT, MLD-C
Enumeration Date: Nov 12, 2024
Last Updated: Nov 12, 2024

Practice Location

Address: 8514 N 128TH EAST AVE
City: Owasso
State: Oklahoma
ZIP Code: 74055-6242
Phone: (316) 833-3505

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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