Individual
DANA ODETALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1417 NW 188TH ST, EDMOND, OK 73012-6209
(405) 888-6656
Mailing address
1417 NW 188TH ST, EDMOND, OK 73012-6209
(405) 888-6656
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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