| Doctor Name: | MRS. MITZI DAVIS BOOTH |
| NPI Number: | 1750469722 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 3142 |
| Business Practice Address: | 2208 W Detroit St Ste 202 Broken Arrow, OK - 740123642 |
| Business Phone Number: | 9188060106 |
| Business Fax Number: | 9188060113 |
| Mailing Address: | 15845 E 77th St N, OWASSO |
| State: | OK |
| Postal Code: | 740557092 |
| Phone Number: | 9182725209 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 05/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3142 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |