MEDICARE: JONATHAN BLUITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1073943882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN BLUITT

Provider Business Mailing Address
First Line	:	6441 N MARTIN LUTHER KING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7912
Country	:	US
Telephone Number	:	405-606-8676
Fax Number	:	405-606-8677

Provider Business Practice Location Address
First Line	:	6441 N MARTIN LUTHER KING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7912
Country	:	US
Telephone Number	:	405-606-8676
Fax Number	:	405-606-8677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	11/14/2013

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Directions to “ JONATHAN BLUITT ” Practice Location

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