Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013259977 |
---|---|
Provider Name | Lawrence William Bradley |
First Address | Oklahoma City, OK 73132-3119 |
Second Address | Oklahoma City, OK 73132-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 19/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ASCX12 | (05) | OK |