Individual
BRIANNA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3635 NW 39TH EXPRESSWAY, OKLAHOMA CITY, OK 73112-6309
(405) 857-8280
Mailing address
1806 24TH AVE NW, NORMAN, OK 73069-6392
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-407919
OK
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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