Individual
JODY MARIE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
629 W MAIN ST, OKLAHOMA CITY, OK 73102-2221
(516) 206-8900
Mailing address
344 ATLANTIC AVE, CEDARHURST, NY 11516-1803
(516) 206-8900
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R382683727
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
OK
Enumeration date
12/17/2024
Last updated
12/17/2024
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