Individual
CARISSA BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
416 W 15TH ST STE 600, EDMOND, OK 73013-3672
(479) 318-2300
Mailing address
500 NW 140TH ST, EDMOND, OK 73013-1913
(918) 972-9311
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-279111
OK
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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