Individual
MARISSA A BUMGARNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
330 W EDMOND RD, EDMOND, OK 73003-5600
(405) 216-3391
(405) 216-3391
Mailing address
330 W EDMOND RD, EDMOND, OK 73003-5600
(405) 216-3391
(405) 216-3391
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-274722
OK
Other
Enumeration date
05/30/2023
Last updated
02/21/2025
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