Individual
SAMUEL BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2248 NW 164TH ST, EDMOND, OK 73013-8801
(405) 562-3776
Mailing address
2248 NW 164TH ST, EDMOND, OK 73013-8801
(405) 562-3776
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-347580
OK
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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