Individual
KENTRELL L GADDIS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4026 NE 19TH CIRCLE, OKC, OK 73121-4604
(405) 589-9260
Mailing address
4026 NE 19TH CIR, OKLAHOMA CITY, OK 73121-4604
(405) 589-9260
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
M999910701
OK
Other
Enumeration date
04/16/2012
Last updated
04/16/2012
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