Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | G000053186 | OK |
NPI | 1003276973 |
---|---|
Provider Name | Lisa Watkins |
First Address | Moore, OK 73170-1256 |
Second Address | Oklahoma City, OK 73170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 04/03/2016 |