Individual
MATT GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 OAK ST # 300, POTEAU, OK 74953-2339
(918) 649-0067
(918) 647-5285
Mailing address
PO BOX 833, POTEAU, OK 74953-0833
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OK
Other
Enumeration date
05/29/2014
Last updated
05/29/2014
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