Healthcare Provider Details

I. General information

NPI: 1073808564
Provider Name (Legal Business Name): LAYU FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 15TH ST APT 47
EDMOND OK
73013-3645
US

IV. Provider business mailing address

501 W 15TH ST APT 47
EDMOND OK
73013-3645
US

V. Phone/Fax

Practice location:
  • Phone: 405-512-1877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: