Individual
MADISON LEA WORCHESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9942B DEBORAH LN, KINGSTON, OK 73439-3905
(580) 565-2651
Mailing address
9942B DEBORAH LN, KINGSTON, OK 73439-3905
(580) 565-2651
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
G083489498
OK
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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