Individual
MISS ASPEN SAGE BAXTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29710 COWBOY DAYS RD, WANETTE, OK 74878-8203
(209) 756-6455
(209) 756-6455
Mailing address
29710 COWBOY DAYS RD, WANETTE, OK 74878-8203
(209) 756-6455
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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