Individual
MALLORY BRIANNE LOWERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
13905 TECHNOLOGY DR STE 1A, OKLAHOMA CITY, OK 73134-1054
(539) 777-0940
Mailing address
800 CHOWNING AVE APT 6, EDMOND, OK 73034-5132
(405) 465-3639
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-156107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YUQ897055988
BLUE CROSS BLUE SHIELD
OK
Enumeration date
02/17/2021
Last updated
02/17/2021
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