Individual
BRIAN KEITH MORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
231 W MAIN ST, MARLOW, OK 73055-2439
(580) 721-7100
Mailing address
231 W MAIN ST, MARLOW, OK 73055-2439
(580) 721-7100
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
850
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTHER
OTHER
—
Enumeration date
05/26/2020
Last updated
05/26/2020
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