Individual
KELLICIA STUART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13404 N MERIDIAN AVE, OKLAHOMA CITY, OK 73120-8311
(405) 752-2264
Mailing address
13404 N MERIDIAN AVE, OKLAHOMA CITY, OK 73120-8311
(405) 752-2264
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21163462
OK
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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