Individual
MIRANDA LYNN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19800 VILLAGE OFFICE CT STE 104, BEND, OR 97702-1813
(541) 306-3483
Mailing address
20184 REED LN APT 334, BEND, OR 97702-3781
(406) 595-5784
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OR
Other
Enumeration date
05/06/2021
Last updated
05/06/2021
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