Individual
MARDIETH A FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 W MAIN ST, ANTLERS, OK 74523-2059
(580) 209-6112
Mailing address
432057 STATE HIGHWAY 3, FORT TOWSON, OK 74735-7506
(580) 372-6516
(580) 209-6179
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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