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Individual

AMANDA GRIFFIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
9236 POLVADORE DRIVE, KINGSTON, OK 73439
(580) 768-5097
Mailing address
PO BOX 1163, KINGSTON, OK 73439-1163
(580) 768-5097

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
N084085894
OK

Other

Enumeration date
02/13/2020
Last updated
02/13/2020
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