Individual
JAMIE TYRELL THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7924 GLORY ROAD, SPENCER, OK 73084
(405) 627-8955
Mailing address
7924 GLORY ROAD, SPENCER, OK 73084
(405) 627-8955
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
T512438831850
FL
Other
Enumeration date
12/27/2011
Last updated
12/27/2011
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