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Individual

BETHANY MOON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
13905 TECHNOLOGY DR, OKLAHOMA CITY, OK 73134-1054
(405) 389-4530
Mailing address
2408 PALOMINO DR, EDMOND, OK 73034-5934
(405) 426-5778

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-234733
OK

Other

Enumeration date
09/26/2022
Last updated
09/26/2022
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