Individual
DEBRA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23 E ROSS AVE, SAPULPA, OK 74066-6423
(918) 216-4999
Mailing address
23 E ROSS AVE, SAPULPA, OK 74066-6423
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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