William Blackwood

Individual provider Active NPI Behavior Technician · Moore, OK

NPI 1649958828 · NPPES record last updated Jul 7, 2023

Key facts

NPI
1649958828
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
License
RBT-23-275736 (OK)
Practice address
146 SW 134TH St
Moore, OK 73170-1488
Phone
(405) 265-9324
NPI assigned
Jul 7, 2023
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
RBT-23-275736OKMDBehavior Technician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-23-275736 OK Yes

Addresses

Primary practice location

146 SW 134TH St
Moore, OK 73170-1488

Mailing address

3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135

Other providers in Moore, OK

All providers in Moore, OK · Behavior Technician in Oklahoma

Sources for this page

Verify at the official NPI Registry.