Individual
BETHANY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34 N WASHINGTON ST, ARDMORE, OK 73401-7013
(580) 670-3117
Mailing address
41247 HIGHWAY 29, WYNNEWOOD, OK 73098-9116
(580) 670-3117
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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