Individual
JACOB ALEXANDER BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1104 COLUMBIA COURT, EDMOND, OK 73003
(405) 240-7003
Mailing address
1104 COLUMBIA CT, EDMOND, OK 73003-6149
(405) 240-7003
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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