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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-275736 | OK | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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All providers in Moore, OK · Behavior Technician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.