Individual
SHAYLA EBISCH-BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
3005 SW PARK AVE, LAWTON, OK 73505-7902
(580) 699-5558
(580) 699-5559
Mailing address
3005 SW PARK AVE, LAWTON, OK 73505-7902
(580) 699-5558
(580) 699-5559
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-122667
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-20-122667
BACB BOARD
OK
Enumeration date
08/20/2020
Last updated
08/20/2020
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