Individual
SANELA NUSSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6913 SW DELTA AVE, LAWTON, OK 73505-6627
(315) 723-6190
Mailing address
6913 SW DELTA AVE, LAWTON, OK 73505-6627
(315) 723-6190
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
08/18/2022
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