Individual
MICHAEL LEON MASHBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19199 S 575 RD, TAHLEQUAH, OK 74464-1879
(918) 931-1951
Mailing address
19199 S 575 RD, TAHLEQUAH, OK 74464-1879
(918) 931-1951
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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