Individual
MANDELINE ELIZABETH BROSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
930 WALL ST, NORMAN, OK 73069-6319
(405) 384-8588
Mailing address
3600 W TECUMSEH RD UNIT 2305, NORMAN, OK 73072-1840
(405) 312-5309
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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