Individual
LOGAN DAVID WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13905 TECHNOLOGY DR, OKLAHOMA CITY, OK 73134-1054
(405) 389-4530
Mailing address
6501 NE 103RD ST, OKLAHOMA CITY, OK 73151-9411
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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