Individual
ANDREA NICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
600 LIBERTY LN, EDMOND, OK 73034-9432
(405) 548-1029
(817) 549-3172
Mailing address
600 LIBERTY LN, EDMOND, OK 73034-9432
(405) 548-1029
(817) 549-3172
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-95997
OK
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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