Individual
JEREMY VANBRUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 304-7323
Mailing address
506 SE 6TH ST, WAGONER, OK 74467-6211
(918) 304-7323
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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