Healthcare Provider Details

I. General information

NPI: 1003742073
Provider Name (Legal Business Name): KANON SPRINGER RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N WASHINGTON AVE
DURANT OK
74701-2128
US

IV. Provider business mailing address

1204 DENISON ST
DURANT OK
74701-2632
US

V. Phone/Fax

Practice location:
  • Phone: 580-706-6936
  • Fax:
Mailing address:
  • Phone: 580-380-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-0566-1209323
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: